Abstract
Disadvantaged socioeconomic status is associated with higher stroke incidence and mortality, and higher readmission rate. We aimed to assess the effect of socioeconomic factors on case fatality, health related quality of life (HRQoL), and satisfaction with care of stroke survivors in the framework of the European Health Care Outcomes, Performance and Efficiency (EuroHOPE) study in Hungary, one of the leading countries regarding stroke mortality. We evaluated 200 consecutive patients admitted for first-ever ischemic stroke in a single center and performed a follow-up at 3 months after stroke. We recorded pre- and post-stroke socioeconomic factors, and assessed case fatality, HRQoL and patient satisfaction with the care received. Stroke severity at onset was scored by the National Institutes of Health Stroke scale (NIHSS), disability at discharge from acute care was evaluated by the modified Rankin Score (mRS). To evaluate HRQoL and patient satisfaction with care we used the EQ-5D-5L, 15D and EORTC IN PATSAT 32 questionnaires. At 3 months after stroke the odds of death was significantly increased by stroke severity (NIHSS, OR = 1.209, 95%CI: 1.125-1.299, p<0.001) and age (OR = 1.045, 95%CI: 1.003-1.089, p = 0.038). In a multiple linear regression model, independent predictors of HRQoL were age, disability at discharge, satisfaction with care, type of social dwelling after stroke, length of acute hospital stay and rehospitalization. Satisfaction with care was influenced negatively by stroke severity (Coef. = -1.111, 95%C.I.: -2.159- -0.062, p = 0.040), and positively by having had thrombolysis (Coef. = 25.635, 95%C.I.: 5.212-46.058, p = 0.016) and better HRQoL (Coef. = 22.858, 95%C.I.: 6.007-39.708, p = 0.009). In addition to age, disability, and satisfaction with care, length of hospital stay and type of social dwelling after stroke also predicted HRQoL. Long-term outcome after stroke could be improved by reducing time spent in hospital, i.e. by developing home care rehabilitation facilities thus reducing the need for readmission to inpatient care.
Highlights
Stroke has a major impact on the quality of life of patients [1, 2], with considerable differences between populations with various socioeconomic background [3]
Stroke severity at onset was scored by the National Institutes of Health Stroke scale (NIHSS), disability at discharge from acute care was evaluated by the modified Rankin Score
In the multiple linear regression model, we have found that out of all the factors assessed (Table 1) the following had a significant independent impact on the health related quality of life (HRQoL) measured by EQ-5D index at 90-days after stroke: age, modified Rankin Score (mRS) at discharge from the acute hospitalization, stroke type, patient satisfaction, acute and post-acute length of hospital stay, and the type of dwelling after stroke (Table 4)
Summary
Stroke has a major impact on the quality of life of patients [1, 2], with considerable differences between populations with various socioeconomic background [3]. People of lower socioeconomic status show higher stroke incidence and mortality, higher severity in the acute phase, higher readmission rate to hospital and lose more disability-adjusted life-years [4,5,6,7]. The impact of differences in social background on post-stroke health-related quality of life (HRQoL) has not been sufficiently evaluated in Central-Eastern European countries. In the EuroHOPE study Hungary had the highest stroke incidence, the largest all-cause case fatality 1 year after stroke and the largest regional differences [16, 17]. We aimed to assess the effect of socioeconomic factors on case fatality, health related quality of life (HRQoL), and satisfaction with care of stroke survivors in the framework of the European Health Care Outcomes, Performance and Efficiency (EuroHOPE) study in Hungary, one of the leading countries regarding stroke mortality
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