Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study
Abstract Background The reasons for socioeconomic inequity in stroke mortality are not well understood. The aim of this study was to explore the role of ischemic stroke care-pathways on the association between education level and one-year survival after hospital admission. Methods Hospitalizations f...
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| Format: | Article |
| Language: | English |
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BMC
2016-05-01
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| Series: | BMC Public Health |
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| Online Access: | http://link.springer.com/article/10.1186/s12889-016-3019-8 |
| _version_ | 1817998845605314560 |
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| author | Valeria Belleudi Paolo Sciattella Nera Agabiti Mirko Di Martino Riccardo Di Domenicantonio Marina Davoli Danilo Fusco |
| author_facet | Valeria Belleudi Paolo Sciattella Nera Agabiti Mirko Di Martino Riccardo Di Domenicantonio Marina Davoli Danilo Fusco |
| author_sort | Valeria Belleudi |
| collection | DOAJ |
| description | Abstract Background The reasons for socioeconomic inequity in stroke mortality are not well understood. The aim of this study was to explore the role of ischemic stroke care-pathways on the association between education level and one-year survival after hospital admission. Methods Hospitalizations for ischemic stroke during 2011/12 were selected from Lazio health data. Patients’ clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. The association between education level and mortality after stroke was studied for acute and post-acute phases using multilevel logistic models (Odds Ratio (OR)). Different scenarios of quality care-pathways were identified considering hospital performance, access to rehabilitation and drug treatment post-discharge. The probability to survive to acute and post-acute phases according to education level and care-pathway scenarios was estimated for a “mean-severity” patient. One-year survival probability was calculated as the product of two probabilities. For each scenario, the 1-year survival probability ratio, university versus elementary education, and its Bootstrap Confidence Intervals (95 % BCI) were calculated. Results We identified 9,958 patients with ischemic stroke, 53.3 % with elementary education level and 3.2 % with university. The mortality was 14.9 % in acute phase and 14.3 % in post-acute phase among survived to the acute phase. The adjusted mortality in acute and post-acute phases decreased with an increase in educational level (OR = 0.90 p-trend < 0.001; OR = 0.85 p-trend < 0.001). For the best care-pathway, the one-year survival probability ratio was 1.06 (95 % BCI = 1.03–1.10), while it was 1.17 (95 % BCI = 1.09–1.25) for the worst. Conclusions Education level was inversely associated with mortality both in acute and post-acute phases. The care-pathway reduces but does not eliminate 1-year survival inequity. |
| first_indexed | 2024-04-14T02:59:29Z |
| format | Article |
| id | doaj.art-a552e5614f2a464d83ab118716996dad |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-14T02:59:29Z |
| publishDate | 2016-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-a552e5614f2a464d83ab118716996dad2022-12-22T02:15:58ZengBMCBMC Public Health1471-24582016-05-011611810.1186/s12889-016-3019-8Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort studyValeria Belleudi0Paolo Sciattella1Nera Agabiti2Mirko Di Martino3Riccardo Di Domenicantonio4Marina Davoli5Danilo Fusco6Department of Epidemiology, Lazio Regional Health ServiceDepartment of Epidemiology, Lazio Regional Health ServiceDepartment of Epidemiology, Lazio Regional Health ServiceDepartment of Epidemiology, Lazio Regional Health ServiceDepartment of Epidemiology, Lazio Regional Health ServiceDepartment of Epidemiology, Lazio Regional Health ServiceDepartment of Epidemiology, Lazio Regional Health ServiceAbstract Background The reasons for socioeconomic inequity in stroke mortality are not well understood. The aim of this study was to explore the role of ischemic stroke care-pathways on the association between education level and one-year survival after hospital admission. Methods Hospitalizations for ischemic stroke during 2011/12 were selected from Lazio health data. Patients’ clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. The association between education level and mortality after stroke was studied for acute and post-acute phases using multilevel logistic models (Odds Ratio (OR)). Different scenarios of quality care-pathways were identified considering hospital performance, access to rehabilitation and drug treatment post-discharge. The probability to survive to acute and post-acute phases according to education level and care-pathway scenarios was estimated for a “mean-severity” patient. One-year survival probability was calculated as the product of two probabilities. For each scenario, the 1-year survival probability ratio, university versus elementary education, and its Bootstrap Confidence Intervals (95 % BCI) were calculated. Results We identified 9,958 patients with ischemic stroke, 53.3 % with elementary education level and 3.2 % with university. The mortality was 14.9 % in acute phase and 14.3 % in post-acute phase among survived to the acute phase. The adjusted mortality in acute and post-acute phases decreased with an increase in educational level (OR = 0.90 p-trend < 0.001; OR = 0.85 p-trend < 0.001). For the best care-pathway, the one-year survival probability ratio was 1.06 (95 % BCI = 1.03–1.10), while it was 1.17 (95 % BCI = 1.09–1.25) for the worst. Conclusions Education level was inversely associated with mortality both in acute and post-acute phases. The care-pathway reduces but does not eliminate 1-year survival inequity.http://link.springer.com/article/10.1186/s12889-016-3019-8Socioeconomic-positionStrokePathway-analysisSurvival |
| spellingShingle | Valeria Belleudi Paolo Sciattella Nera Agabiti Mirko Di Martino Riccardo Di Domenicantonio Marina Davoli Danilo Fusco Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study BMC Public Health Socioeconomic-position Stroke Pathway-analysis Survival |
| title | Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study |
| title_full | Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study |
| title_fullStr | Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study |
| title_full_unstemmed | Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study |
| title_short | Socioeconomic differences in one-year survival after ischemic stroke: the effect of acute and post-acute care-pathways in a cohort study |
| title_sort | socioeconomic differences in one year survival after ischemic stroke the effect of acute and post acute care pathways in a cohort study |
| topic | Socioeconomic-position Stroke Pathway-analysis Survival |
| url | http://link.springer.com/article/10.1186/s12889-016-3019-8 |
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