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(Stroke. 2008;39:2066.)
© 2008 American Heart Association, Inc.

Original Contributions

Influence of Socioeconomic Status and Gender on Stroke Treatment and Diagnostics

Jasmin Arrich, MD; Marcus Müllner, MD, MSc; Wolfgang Lalouschek, MD; Stefan Greisenegger, MD; Richard Crevenna, MD Harald Herkner, MD, MSc

From the Department of Emergency Medicine (J.A., H.H.), Department of Neurology (W.L., S.G.), and Department of Physical Medicine and Rehabilitation (R.C.), Medical University Vienna, Vienna General Hospital, Österreichische Agentur für Gesundheit und Ernährungssicherheit, AGES (M.M.), Austria.

Correspondence to Harald Herkner, MD, Department of Emergency Medicine, Medical University Vienna, Vienna General Hospital, Währinger Gürtel 18-20/6D, Austria. E-mail harald.herkner{at}meduniwien.ac.at

Background and Purpose— Female patients and patients with a lower level socioeconomic status (SES) often experience less favorable health outcomes. We aimed to investigate whether gender and socioeconomic status of patients with acute ischemic stroke or transient ischemic attack are associated with different diagnostic and treatment strategies.

Methods— The risk factors of interest were gender and SES. We predefined our diagnostic and treatment end points according to current stroke guidelines and used multivariate models to adjust for age, stroke severity, and comorbidities.

Results— A total of 2606 patients were included in the analysis. Women were less likely to receive antiplatelet agents within the first 48 hours after admission (OR: 0.59, 95% CI: 0.53 to 0.89) and more likely to have their blood glucose measured on admission than men (OR: 1.52, 95% CI: 1.1 to 2.1). With higher SES patients were more likely to receive a TTE or TTE during hospital stay. Women were almost twice as likely to receive a prescription for antidepressants at discharge OR of 1.96 (95% CI: 1.48 to 2.59).

Conclusion— Socioeconomic status and gender are associated with some diagnostic and treatment differences of acute ischemic stroke. Most pronounced were a reduced chance for women to receive antiplatelet therapy on admission and a reduced chance for a TTE and TEE with a lower level of SES, whereas the rate of thrombolysis was unbiased by gender and SES.

Key Words: cerebrovascular accident • social class • female • male • therapy