Socioeconomic Differences In Quality Research Articles

Socioeconomic Differences in Quality of Care and Clinical Outcome After Stroke

The association among socioeconomic status, quality of care, and clinical outcome after stroke remains poorly understood. In a Danish nationwide follow-up study, we examined whether socioeconomic-related differences in acute stroke care occur and, if so, whether they explain socioeconomic differences in case-fatality and readmission risk. Using population-based public registries, we identified and followed all patients aged≤65 years admitted with stroke from 2003 to 2007 (n=14,545). We compared the proportion of patients receiving 7 specific processes of care according to income, educational attainment, and employment status. Furthermore, we computed 30-day and 1-year hazard ratios for death and readmission adjusted for patient characteristics and received processes of acute stroke care. For low-income patients and disability pensioners, the relative risk of receiving all of the relevant processes of care was 0.82 (95% CI, 0.78 to 0.86) and 0.83 (95% CI, 0.79 to 0.87), respectively, compared with high-income patients and employed patients. Adjusted 30-day and 1-year hazard ratios for death for unemployed patients were 1.57 (95% CI, 1.25 to 1.97) and 1.58 (1.32 to 1.88), respectively, compared with employed patients. Unemployed patients also had a higher risk of readmission. The differences in mortality and readmission risk remained after controlling for received processes of acute stroke care. Low socioeconomic status was associated with a lower chance of receiving optimal acute stroke care. However, the differences in acute care did not appear to explain socioeconomic differences in mortality and readmission risk.

Socio-economic position and quality of life among older people in 10 European countries: results of the SHARE study

This study examines associations between quality of life and multiple indicators of socio-economic position among people aged 50 or more years in 10 European countries, and analyses whether the relative importance of the socio-economic measures vary by age. The data are from the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2004. 15,080 cases were analysed. Quality of life was measured by a short version of the CASP-19 questionnaire, which represents quality of life as comprising four conceptual domains of individual needs that are particularly relevant in later life: control (C), autonomy (A), self-realisation (S) and pleasure (P). The short version has 12 items (three for each domain). Five indicators of socio-economic position were used: income, education, home ownership, net worth, and car ownership. A multiple logistic regression showed that quality of life was associated with socio-economic position, but that the associations varied by country. Relatively small socio-economic differences in quality of life were observed for Switzerland, but comparatively large differences in Germany. Education, income, net worth, and car ownership consistently related to quality of life, but the association of home ownership was less consistent. There was no indication that the socio-economic differences in quality of life diminished after retirement (i.e. from 65+ years). Conventional measures of socio-economic position (education and income), as well as alternative indicators (car ownership and household net worth), usefully identified the differential risks of poor quality of life among older people before and after the conventional retirement age.