Vivek Rai, MD
Socioeconomic deprivation (SED) has been implicated in increased risk of stroke and increased mortality afterwards. The data about SED affecting long term outcomes after stroke is rather inconsistent. In the West the number of Black and Minority Ethnic (BME) populations has been increasing over the last 2 decades, and patients of BME groups are more likely to experience socioeconomic disadvantage and health care inequality. In this retrospective analysis, Chen et al investigated the association of SED and short and long term survival after stroke in multi-ethnic study population in stroke register in England.
The authors used Carstairs Index (A validated index of SED based on four census indicators: low social class, lack of car ownership, overcrowding and male unemployment) to define the severity of SED. Data from 4398 patients of stroke, collected between 1995 to 2011 using a prospective stroke registry, was analyzed. Patients with severe SED had significantly high mortality (Hazard Ratio = 1.23 for 3-month-mortality and 1.13 for 17-year-mortality). Black patients with 4th quartile SED had increased 3-month mortality but this was not significant when adjusted for acute stroke care provisions.
This is yet another study that demonstrates disparity in health care and health outcomes based on socioeconomic factors. Similar results have been shown in US, Canada, Austria and China. The study highlights the need to identify these patients and involve them and their families in health care. How do we achieve that? Can these studies help in formulating healthcare policies that result in more equitable outcomes? How can physicians contribute? So far, these are some of the questions that remain unanswered.