Socioeconomic deprivation and survival after stroke in China: a systematic literature review and a new population-based cohort study.

摘要

Objective: To assess the association ofudsocioeconomic deprivation (SED) with survival afterudstroke in China.udDesign: A systematic literature review and a newudpopulation-based cohort study.udSetting and participants: In urban and ruraludcommunities in Anhui, China, 2978 residents agedud≥60 years took part in baseline investigation and wereudfollowed up for 5 years; five published studies wereudidentified for a systematic review.udPrimary and secondary outcome measures: 167udof 2978 participants (5.6%) had doctor-diagnosedudstroke at baseline or 1 year later. All-cause mortality inudthe follow-up.udResults: In the Anhui cohort follow-up of 167 patientsudwith stroke, 64 (38.3%) died. Multivariate adjustedudhazard ratio (HR) of mortality in patients withudeducational level of less than or equal to primaryudschool was 1.88 (95% CI 1.05 to 3.36) compared toudthose having more than primary school education.udIncreased HR of mortality in patients living in a ruraludarea was at borderline significant (1.64, 0.97 to 2.78),udbut the HR in patients with lower levels of occupationudand income was not significant. Published studiesudshowed a significant increase in stroke mortality inudrelation to some SED indicators. Pooled relative riskud(RR) of mortality in patients with low education wasud3.07 (1.27 to 7.34), in patients with low income 1.58ud(1.50 to 1.65) and in patients living in rural areas 1.47ud(1.37 to 1.58).udConclusions: The evidence suggests the presence ofuda mortality gradient after stroke for material as well asudsocial forms of deprivation in China. Inequalities inudsurvival after stroke persist and need to be taken intoudaccount when implementing intervention programmes.