Association Between Socioeconomic Deprivation and Functional Impairment After Stroke

Abstract

Background and Purpose— Previous findings of the association between socioeconomic deprivation and functional impairment after stroke are inconsistent. There is a lack of data on long-term association. We assessed the association and differences by age, sex, prestroke comorbidities, and stroke phenotypes. Methods— We examined data from the South London Stroke Register cohort of 1995 to 2011, recording all first-ever strokes in patients of all ages in South London. A total of 2104 patients were alive at 3 months after stroke. Socioeconomic deprivation was measured using the index of multiple deprivation based on patient postcodes, and functional impairment after stroke was defined as a Barthel index of <15. Results— At 3 months after stroke, 643 patients had functional impairment (30.6%; 95% confidence interval, 28.6%–32.5%). Compared with the first quartile of index of multiple deprivation (the least deprived), multivariate-adjusted odds ratios for functional impairment in patients with the second, third, and fourth quartiles were 1.29 (95% confidence interval, 0.94–1.76), 1.33 (0.97–1.82), and 1.78 (1.31–2.43), overall P =0.004. The association was significant in patients aged ≥65 years (corresponding odds ratios were 1.49 [1.02–2.17], 1.21 [0.83–1.75], and 1.94 [1.34–2.81]; P =0.003); in women, P =0.008, in patients who do not have prestroke comorbidities, P =0.009, and in patients with ischemic stroke, P <0.001, but not significant in their counterpart patients. There were similar patterns of the associations of socioeconomic deprivation with impairment at 3 years after stroke. Conclusions— There are significant inequalities in short- and long-term functional recovery after stroke. General socioeconomic improvement, targeting groups at high risk of functional impairment is likely to reduce inequality in functional recovery after stroke.