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ABSTRACT
Background: Previous studies have conflicting results on the association between socioeconomic status and stroke outcomes. Thus, this study aimed to investigate whether socioeconomic status is associated with the prognosis of ischemic stroke in Guangzhou, South China.
Methods: A total of 622 patients with ischemic stroke who were admitted in the neurology department of five general hospitals in Guangzhou from May 2014 to October 2014 were included in the study. Socioeconomic status was measured based on education, income, caregiver, and insurance. The modified Rankin scale was used to evaluate the two years prognosis of patients with stroke. A multivariate logistic regression model was performed to determine the association between socioeconomic status and ischemic stroke prognosis.
Results: In 2 years follow-up, 542 ischemic stroke patients were interviewed by telephone. Age ranged from 31 to 96 years, 65.5% of the patients were male. 33.9% of patients with ischemic stroke had a poor prognosis. After adjustment for age, sex, cardiovascular disease, behavior lifestyle, and severity of stroke, odds ratio for poor prognosis in patients with low income was 1.84 (95%CI 1.05–3.22), family caregiver 3.19 (95%CI 1.05–9.70), and no insurance 1.68 (95%CI 1.02–2.77).
Conclusions: Patients with low income, family caregiver, and no insurance have a poorer prognosis after ischemic stroke that can be partly explained by intermediate variable in the patients’ demographic characteristics, cardiovascular disease, behavior lifestyle, and stroke severity.
Abbreviations: DALYs: disability-adjusted life years; SES: socioeconomic status; FMC: free medical care; MIUR: medical insurance for urban residents; MIUE: medical insurance for urban employees; NCMS: new rural cooperative medical scheme ; NIHSS: National Institute of Health Stroke Scale ; mRS: modified Rankin scale; OR: odds ratios; CI: confidence interval
Acknowledgments
The authors thank the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong Province Hospital of Chinese Medicine, NANFANG HOSPITAL, ZhuJiang Hospital of Southern Medical University, the First Affiliated Hospital of JiNan University for participating the study. We also thank all the patients and their families involved.
Author Contributions
WSP, WMT, and WJ designed the study and generated the questionnaires. WSP, WMT, and SBY conducted data collection and data analyses. WL and WJ provided critical review of the manuscript. All authors participated in the interpretation of the data and approved the final draft.
Statement of Ethics
Subjects (or their parents or guardians) have given their written informed consent.
The study protocol has been approved by ethics committee of First Affiliated Hospital of Guangdong Pharmaceutical University.
Disclosure statement
No potential conflict of interest was reported by the authors.
Additional information
Funding
Notes on contributors
Siping Wang
Siping Wang is a nurse practitioner with a Masters’ degree candidate in Nursing and holds a diploma in Community nursing. She has two publications in the field of socioeconomic status and stroke. She researches on the management of chronic disease.
Binyan Shen
Binyan Shen is a nurse with a Masters’ degree candidate in Nursing and holds a diploma in nursing. She has a publication in the field of socioeconomic status and stroke. She researches on the management of chronic disease and the Internet medical.
Lin Wei
Lin Wei is a co-chief nurse with Doctor of medicine and a master supervisor in Nursing. He is a deputy director of the nursing department of Guangdong Province Hospital of Chinese Medicine, an adjunct professor of Guangzhou university of Chinese medicine and Guangdong pharmaceutical university, a deputy director of the research institute of medical and nursing integration of Guangzhou Charity Hospital. She is the main person in charge of the training course of specialist nurses in the field of geriatric nursing jointly organized by Guangdong and Hong Kong. She researches on geriatric care, chronic disease management, nursing education and rehabilitation nursing. She is a reviewer in Journal of Nursing and an editor in Nursing of Integrated Traditional Chinese and Western Medicine. She has several publications and three patents for invention in the field of chronic diseases management. She establishes a hospital-community-home trinity model with Chinese medicine characteristics and the first health care combined outpatient.
Meiting Wu
Meiting Wu is a supervisor nurse with Masters’ degree candidate in Nursing and holds a diploma in nursing. She has a publication in the field of socioeconomic status and stroke management. She researches on the management of chronic disease.
Juan Wang
Juan Wang is an associate professor with a Doctor of Medicine in Neurology and a master supervisor in Nursing. She is a member of the standing committee of neuronursing professional committee of Guangdong nursing association, a member of the standing committee of nursing professional committee of Guangdong traditional medical association and a reviewer in Chinese Journal of Arteriosclerosis. She has several publications and two software copyrights in the field of chronic diseases management. She researches on multi-disciplinary management of chronic diseases. She combines mobile Internet and chronic disease management, explores and innovates a new mode of online health care for chronic diseases, and establishes a win-win intelligent medical ecological environment for hospitals, communities, families and society.