Socioeconomic inequities in mortality and functional outcome after stroke in Zanzibar: A prospective cohort study
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Socioeconomic inequities in mortality and functional outcome after stroke in Zanzibar : A prospective cohort study. / Jørgensen, Jutta M.Adelin; Nielsen, Karoline Kragelund; Petersen, Jørgen Holm; Sadiq, Halima Saleh; Kelly, Zoe Frances; Walker, Richard William; Christensen, Dirk Lund.
In: Journal of Stroke and Cerebrovascular Diseases, Vol. 32, No. 5, 107081, 2023.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Socioeconomic inequities in mortality and functional outcome after stroke in Zanzibar
T2 - A prospective cohort study
AU - Jørgensen, Jutta M.Adelin
AU - Nielsen, Karoline Kragelund
AU - Petersen, Jørgen Holm
AU - Sadiq, Halima Saleh
AU - Kelly, Zoe Frances
AU - Walker, Richard William
AU - Christensen, Dirk Lund
N1 - Publisher Copyright: © 2023 The Authors
PY - 2023
Y1 - 2023
N2 - Objectives: To characterise mortality and functional outcome and their relationships with socioeconomic deprivation for women and men in Zanzibar. Materials and methods: Participants in ZanStroke, a prospective observational study of patients admitted to hospital with a diagnosis of acute stroke, were followed up until one year after the stroke. The modified National Institute of Health Stroke Scale was used to assess initial stroke severity, while modified Rankin Scale (mRS) was used to assess disability at 12 months post-stroke. A multidimensional poverty index was created using individual-level data. Kaplan-Meier analysis and Cox regression model were used to examine associations of socioeconomic deprivation and death at 28 days and 12 months after stroke onset, while logistic regression analysis was used to examine associations between deprivation and functional outcome. Results: Overall mortality rate was 38.2% (CI 34.8-41.9) at 28 days, rising to 59.0% (CI 55.2-62.8) at 12 months. When adjusted for other variables, survival was higher among the least deprived (HR 0.60 CI 0.45-0.80), an association that was strongly significant for women (HR 0.46 CI 0.29-0.74). Among 12-month survivors 45.1% (n = 122) had no/low level of disability (mRS 0-2), while 22.9% (n = 62) were unable to walk independently or at all. No difference between socioeconomic deprivation and outcome was seen at one year. Conclusion: Case-fatality rates were high, and socioeconomic disparities were evident even during the acute stroke phase. Policies are needed to reduce significant health disparities, adapt evidence-based interventions, and promote equitable access to stroke care and rehabilitation.
AB - Objectives: To characterise mortality and functional outcome and their relationships with socioeconomic deprivation for women and men in Zanzibar. Materials and methods: Participants in ZanStroke, a prospective observational study of patients admitted to hospital with a diagnosis of acute stroke, were followed up until one year after the stroke. The modified National Institute of Health Stroke Scale was used to assess initial stroke severity, while modified Rankin Scale (mRS) was used to assess disability at 12 months post-stroke. A multidimensional poverty index was created using individual-level data. Kaplan-Meier analysis and Cox regression model were used to examine associations of socioeconomic deprivation and death at 28 days and 12 months after stroke onset, while logistic regression analysis was used to examine associations between deprivation and functional outcome. Results: Overall mortality rate was 38.2% (CI 34.8-41.9) at 28 days, rising to 59.0% (CI 55.2-62.8) at 12 months. When adjusted for other variables, survival was higher among the least deprived (HR 0.60 CI 0.45-0.80), an association that was strongly significant for women (HR 0.46 CI 0.29-0.74). Among 12-month survivors 45.1% (n = 122) had no/low level of disability (mRS 0-2), while 22.9% (n = 62) were unable to walk independently or at all. No difference between socioeconomic deprivation and outcome was seen at one year. Conclusion: Case-fatality rates were high, and socioeconomic disparities were evident even during the acute stroke phase. Policies are needed to reduce significant health disparities, adapt evidence-based interventions, and promote equitable access to stroke care and rehabilitation.
KW - Functional outcome after stroke
KW - Low- and middle-income countries
KW - Socioeconomic deprivation
KW - Stroke mortality
KW - Sub-Saharan Africa
U2 - 10.1016/j.jstrokecerebrovasdis.2023.107081
DO - 10.1016/j.jstrokecerebrovasdis.2023.107081
M3 - Journal article
C2 - 36931091
AN - SCOPUS:85150033224
VL - 32
JO - Journal of Stroke & Cerebrovascular Diseases
JF - Journal of Stroke & Cerebrovascular Diseases
SN - 1052-3057
IS - 5
M1 - 107081
ER -
ID: 340529980