Background and Purpose:There is evidence of unequal access to health care int erventions even where universal health systems operate. We investigated associat ions between patients’sociodemographic characteristics an...Background and Purpose:There is evidence of unequal access to health care int erventions even where universal health systems operate. We investigated associat ions between patients’sociodemographic characteristics and the provision of acu te and longer-term stroke care in a multiethnic urban population.Methods:We us ed data from 1635 patients with first-ever stroke, collected by a population-b ased stroke register from 1995 to 2000. Using multivariable analyses, controlled for sociodemographic and clinical factors, we investigated access to 22 evidenc e-based components of care. Results:1392 patients(85.1%) were admitted to hos pital; of these, 354 (25.4%) were admitted or transferred to a stroke unit. Of those with clinical need, 607 (70.7%) received physical therapies; 477 (59.8%) received speech and language therapy. Older age was associated with lower odds of hospitalization (odds ratio [OR], 0.50; 95%CI, 0.32 to 0.77, P=0.02) and dia gnostic brain imaging (OR,0.15; 95%CI, 0.08 to 0.30, P < 0.01) but higher odds of receiving physical therapy (OR, 4.24;95%CI, 1.22 to 14.73,P < 0.01).Black et hnicity was associated with higher odds of stroke unit admission (OR, 1.59; 95% CI, 1.01 to 2.49, P < 0.04). There was a weak association between socioeconomic status and admission to hospital and stroke unit. Gender was associated only wit h treatment of hypertension before stroke. Conclusions:Provision of individual components of care over 1 year varied for specific sociodemographic categories, but there was no consistent pattern of in equality. Clinical decision-making pr ocesses are likely to influence these patterns. Further information about clinic ian and patient roles in decision making is required.展开更多
Objectives: To identify ethnic differences in survival after stroke and examine the factors that influence survival. Design: Population based stroke register with follow-up. Settings: South London stroke register. Par...Objectives: To identify ethnic differences in survival after stroke and examine the factors that influence survival. Design: Population based stroke register with follow-up. Settings: South London stroke register. Participants: 2321 patients with first stroke registered between January 1995 and December 2002. Main outcome measures: Sociodemographic factors, risk factors for stroke and their management, severity of stroke, and acute service provision factors. Survival analysis with Kaplan-Meier curves, log rank test, and Cox’s proportional hazard model with stratification. Results: In univariable analyses of survival, outcome was better for black people than white people (median 33.7 v 20.0 months). After stratification by socioeconomic status, type of stroke, and Glasgow coma score, and adjustment for other potential confounders, being black was generally associated with better survival, taking into account the interaction between ethnicity and age, and ethnicity and prior Barthel score. Of the risk factors for stroke considered, current smoking (hazard ratio 1.21, 95%confidence interval 1.01 to 1.45, P = 0.044), untreated atrial fibrillation (1.36, 1.08 to 1.72, P = 0.009), untreated diabetes (1.53, 1.05 to 2.22, P = 0.027), and treated diabetes (1.61, 1.27 to 2.03, P < 0.001) were associated with reduced survival. Conclusion: In general, black patients in a south London population with first ever stroke are more likely to survive than white patients, the exceptions being in those aged < 65 and those with a prior Barthel score < 15. Some pre-stroke risk factors that have the potential to be modified, including the appropriate treatment of existing health problems, have a strong impact on survival.展开更多
文摘Background and Purpose:There is evidence of unequal access to health care int erventions even where universal health systems operate. We investigated associat ions between patients’sociodemographic characteristics and the provision of acu te and longer-term stroke care in a multiethnic urban population.Methods:We us ed data from 1635 patients with first-ever stroke, collected by a population-b ased stroke register from 1995 to 2000. Using multivariable analyses, controlled for sociodemographic and clinical factors, we investigated access to 22 evidenc e-based components of care. Results:1392 patients(85.1%) were admitted to hos pital; of these, 354 (25.4%) were admitted or transferred to a stroke unit. Of those with clinical need, 607 (70.7%) received physical therapies; 477 (59.8%) received speech and language therapy. Older age was associated with lower odds of hospitalization (odds ratio [OR], 0.50; 95%CI, 0.32 to 0.77, P=0.02) and dia gnostic brain imaging (OR,0.15; 95%CI, 0.08 to 0.30, P < 0.01) but higher odds of receiving physical therapy (OR, 4.24;95%CI, 1.22 to 14.73,P < 0.01).Black et hnicity was associated with higher odds of stroke unit admission (OR, 1.59; 95% CI, 1.01 to 2.49, P < 0.04). There was a weak association between socioeconomic status and admission to hospital and stroke unit. Gender was associated only wit h treatment of hypertension before stroke. Conclusions:Provision of individual components of care over 1 year varied for specific sociodemographic categories, but there was no consistent pattern of in equality. Clinical decision-making pr ocesses are likely to influence these patterns. Further information about clinic ian and patient roles in decision making is required.
文摘Objectives: To identify ethnic differences in survival after stroke and examine the factors that influence survival. Design: Population based stroke register with follow-up. Settings: South London stroke register. Participants: 2321 patients with first stroke registered between January 1995 and December 2002. Main outcome measures: Sociodemographic factors, risk factors for stroke and their management, severity of stroke, and acute service provision factors. Survival analysis with Kaplan-Meier curves, log rank test, and Cox’s proportional hazard model with stratification. Results: In univariable analyses of survival, outcome was better for black people than white people (median 33.7 v 20.0 months). After stratification by socioeconomic status, type of stroke, and Glasgow coma score, and adjustment for other potential confounders, being black was generally associated with better survival, taking into account the interaction between ethnicity and age, and ethnicity and prior Barthel score. Of the risk factors for stroke considered, current smoking (hazard ratio 1.21, 95%confidence interval 1.01 to 1.45, P = 0.044), untreated atrial fibrillation (1.36, 1.08 to 1.72, P = 0.009), untreated diabetes (1.53, 1.05 to 2.22, P = 0.027), and treated diabetes (1.61, 1.27 to 2.03, P < 0.001) were associated with reduced survival. Conclusion: In general, black patients in a south London population with first ever stroke are more likely to survive than white patients, the exceptions being in those aged < 65 and those with a prior Barthel score < 15. Some pre-stroke risk factors that have the potential to be modified, including the appropriate treatment of existing health problems, have a strong impact on survival.
