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Socioeconomic Differences in Patient Reported Outcome Measures 3 Months After Stroke: A Nationwide Swedish Register-Based Study
Department of Statistics, Umeå School of Business, Economics and Statistics, Umeå University, Sweden.
Örebro University, School of Medical Sciences. School of Medicine, Department of Neurology and Rehabilitation, Örebro University, Sweden.ORCID iD: 0000-0002-3845-8100
Department of Public Health and Clinical Medicine, Umeå University, Sweden. (E.-L.G.).
Institute of Neuroscience and Physiology, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, and the Sahlgrenska University Hospital, Sweden .
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2024 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 55, no 8, p. 2055-2065Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is a well-known association between low socioeconomic status (SES), poor survival, and clinician-reported outcomes after stroke. We aimed to assess socioeconomic differences in Patient Reported Outcome Measures 3 months after stroke.

METHODS: This nationwide cohort study included patients registered with acute stroke in the Swedish Stroke Register 2015-2017. Patient Reported Outcome Measures included activities of daily living (mobility, toileting, and dressing), and poststroke symptoms (low mood, fatigue, pain, and poor general health). Information on SES prestroke was retrieved from Statistics Sweden and defined by a composite measure based on education and income tertiles. Associations between SES and Patient Reported Outcome Measures were analyzed using logistic regression adjusting for confounders (sex and age) and additionally for potential mediators (stroke type, severity, cardiovascular disease risk factors, and living alone). Subgroup analyses were performed for stroke type, men and women, and younger and older patients.

RESULTS: The study included 44 511 patients. Of these, 31.1% required assistance with mobility, 18% with toileting, and 22.2% with dressing 3 months after stroke. For poststroke symptoms, 12.3% reported low mood, 39.1% fatigue, and 22.7% pain often/constantly, while 21.4% rated their general health as poor/very poor. Adjusted for confounders, the odds of needing assistance with activities of daily living were highest for patients with low income and primary school education, for example, for mobility, odds ratio was 2.06 (95% CI, 1.89-2.24) compared with patients with high income and university education. For poststroke symptoms, odds of poor outcome were highest for patients with low income and university education (eg, odds ratio, 1.79 [95% CI, 1.49-2.15] for low mood). Adjustments for potential mediators attenuated but did not remove associations. The associations were similar in ischemic and hemorrhagic strokes and more pronounced in men and patients <65 years old.

CONCLUSIONS: There are substantial SES-related differences in Patient Reported Outcome Measures poststroke. The more severe outcome associated with low SES is more pronounced in men and in patients of working age.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2024. Vol. 55, no 8, p. 2055-2065
Keywords [en]
Patient Reported Outcome Measures, activities of daily living, health status, low socioeconomic status, stroke
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-114543DOI: 10.1161/STROKEAHA.124.047172ISI: 001272487000011PubMedID: 38946533Scopus ID: 2-s2.0-85199283597OAI: oai:DiVA.org:oru-114543DiVA, id: diva2:1880574
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00852Swedish Research Council, 2018-02670Available from: 2024-07-01 Created: 2024-07-01 Last updated: 2024-08-19Bibliographically approved

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