Social deprivation may have a deleterious influence on post-stroke outcomes, but available data in the literature are mixed.
The aim of this cohort study was to evaluate the impact of social deprivation on one-year survival in patients with first-ever stroke.
Social deprivation was assessed at individual level with the EPICES score, a validated multidimensional questionnaire, in 1312 patients with ischemic stroke (IS), and 228 patients with spontaneous intracerebral hemorrhage (ICH), who were prospectively enrolled in six French study centers. Baseline characteristics including stroke severity and prestroke functional status were collected. Multivariable Cox models were generated to evaluate the associations between social deprivation and survival at 12 months in IS and ICH separately.
A total of 819 patients (53.2%) were socially deprived (EPICES score≥30.17). In IS, mortality at 12 months was higher in deprived than in non-deprived patients (16% versus 11%, p=0.006). In multivariable analyses, there was no association between deprivation and death occurring within the first 90 days following IS (adjusted hazard ratio [aHR]=0.81, 95% CI:0.54-1.22, p=0.32). In contrast, an excess in mortality was observed between 90 days and 12 months in deprived compared with non-deprived patients (aHR=1.97; 95%CI:1.14-3.42, p=0.016). In patients with ICH, mortality at 12 months did not significantly differ according to deprivation status.
Social deprivation was associated with delayed mortality in ischemic stroke patients only, and, although the exact underlying mechanisms are still to be identified, our findings suggest that deprived patients in particular may benefit from an optimization of post-stroke care.
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