Socioeconomic Status And Acute Stroke Care: Has The Inequality Gap Been Closed?

Abstract

Purpose

Socioeconomic inequality in stroke care occurs even in countries with free access to health care. We aimed to investigate the association between socioeconomic status and guideline-recommended acute care in Denmark during the last decade.

Design

We conducted a nationwide, population-based study. We used household income, employment status, and education as markers of socioeconomic status and adjusted the results for relevant clinical covariates. We used weighted linear regression models to analyse empirical log odds of performance measure fulfillment at patient level.

Setting

Public hospitals in Denmark.

Participants

A total of 110,848 consecutive stroke patients discharged between 2004 and 2014.

Intervention(s)

Acute stroke care according to clinical guidelines.

Main outcome measure(s)

Guideline-recommended care was defined in two ways based on clinical performance measures: the percentage of fulfilled measures used throughout the study period (m=8) (model 1) and the percentage of fulfilled measures used at the time of discharge (m=8 to 16) (model 2).

Results

Compared with high family income, low income was negatively associated with the guideline-recommended care; odds ratios (95% CI) were 0.89 (0.85–0.93) in model 1 and 0.81 (0.77–0.85) in model 2. Low family income was negatively associated with fulfillment of 14 of the 16 performance measures. In general, the percentage of performance measures fulfilled increased over time from 70% (95% CI 63–76) to 85% (95% CI 83–87).

Conclusion

Socioeconomic inequality in guideline-recommended stroke care remains despite overall improvements in a setting with free access to care and systematic monitoring of health care quality.

Keywords:

• quality of care
• access to care
• health inequality
• stroke

Perspectives/Implications

Socioeconomic inequality seems to persist in acute stroke care even after a decade of systematic monitoring of clinical performance. The observed trend of increasing inequality in relation to the more recent measures of guideline-recommended care warrants specific consideration. The policy implication of these findings might be that even in a setting of proclaimed equal access to health care, additional effort is required to decrease socioeconomic inequality, especially when guideline-recommended care becomes further sophisticated through the addition of new components.

Disclosure

None of the authors have any conflicts of interest to declare in this work.