Risk Factors, Presentation, and Outcome in Acute Stroke according to Social Position Indicators in Patients Hospitalised in a Referral Centre in Bogotá 2011–2019

Abstract

<b><i>Introduction:</i></b> Treatment of stroke is time-dependent and it challenges patients’ social and demographic context for timely consultation and effective access to reperfusion therapies. <b><i>Objective:</i></b> The objective of this study was to relate indicators of social position to cardiovascular risk factors, time of arrival, access to reperfusion therapy, and mortality in the setting of acute stroke. <b><i>Methods:</i></b> A retrospective analysis of patients with a diagnosis of ischaemic stroke in a referral hospital in Bogotá was performed. A simple random sample with a 5% margin of error and 95% confidence interval was selected. Patients were characterised according to educational level, place of origin, marital status, occupation, duration of symptoms before consultation, cardiovascular risk factors, access to reperfusion therapy, and mortality during hospitalisation. <b><i>Results:</i></b> 558 patients were included with a slight predominance of women. Diagnosis of diabetes was more common in women and smoking in men (<i>n</i> = 68, 28.4% vs. <i>n</i> = 51, 15.9%; <i>p</i> = 0.0004). Rural origin was associated with higher prevalence of hypertension, diabetes, and dyslipidaemia (hypertension <i>n</i> = 45, 73.8% vs. <i>n</i> = 282, 57.4%; <i>p</i> = 0.007; diabetes <i>n</i> = 20, 33.3% vs. 109, 19.5%; <i>p</i> = 0.02; dyslipidaemia <i>n</i> = 19, 32.7% vs. <i>n</i> = 93, 18.9%; <i>p</i> = 0.02). Mortality was higher in rural patients (<i>n</i> = 8, 14.2% vs. <i>n</i> = 30, 6.1%; <i>p</i> = 0.03). Lower schooling was associated with higher frequency of hypertension and dyslipidaemia (hypertension <i>n</i> = 152, 76.0% vs. <i>n</i> = 94, 46.3%; <i>p</i> ≤ 0.0001; dyslipidaemia <i>n</i> = 56, 28% vs. <i>n</i> = 35, 17.0%; <i>p</i> = 0.009) as well as with late consultation (<i>n</i> = 30, 15% vs. <i>n</i> = 59, 28.7%; <i>p</i> = 0.0011) and lower probability of accessing reperfusion therapy (<i>n</i> = 12, 6% vs. <i>n</i> = 45, 22%; <i>p</i> ≤ 0.0001). Formal employment was associated with a visit to the emergency department in less than 3 h (<i>n</i> = 50, 25.2% vs. <i>n</i> = 58, 18%, <i>p</i> = 0.04 and a higher probability of accessing reperfusion therapy (<i>n</i> = 35, 17.6% vs. <i>n</i> = 33, 10.2%; <i>p</i> = 0.01). Finally, living in a household with a stratum higher than 3 was associated with a consultation before 3 h (<i>n</i> = 77, 25.5% vs. <i>n</i> = 39, 15.6%; <i>p</i> = 0.004) and a higher probability of reperfusion therapy (<i>n</i> = 57, 18.9% vs. <i>n</i> = 13, 5.2%; <i>p</i> ≤ 0.0001). <b><i>Conclusion:</i></b> Indicators of socio-economic status are related to mortality, consultation time, and access to reperfusion therapy. Mortality and reperfusion therapy are inequitably distributed and, therefore, more attention needs to be directed to the cause of these disparities in order to reduce the access gap in the context of acute stroke in Bogotá.