GAH!!! The Stupidity.
http://stroke.ahajournals.org/content/early/2014/07/29/STROKEAHA.114.005323.abstract?sid=f5ba2ff2-c68f-4a20-9420-a2bf07af24c0
- Anna Stecksén, RPT, MSc,
- Eva-Lotta Glader, MD, PhD,
- Kjell Asplund, MD, PhD,
- Bo Norrving, MD, PhD and
- Marie Eriksson, PhD
+ Author Affiliations
- Correspondence to Anna Stecksén, RPT, MSc, Department of Public Health and Clinical Medicine, Umeå University, S-901 87 Umeå, Sweden. E-mail anna.stecksen@medicin.umu.se
Abstract
Background and Purpose—Previous
studies have revealed inequalities in stroke treatment based on
demographics, hospital type, and region. We used
the Swedish Stroke Register (Riksstroke) to
test whether patient education level is associated with reperfusion
(either or
both of thrombolysis and thrombectomy)
treatment.
Methods—We included
85 885 patients with ischemic stroke aged 18 to 80 years registered in
Riksstroke between 2003 and 2009. Education
level was retrieved from Statistics Sweden,
and thrombolysis, thrombectomy, patient, and hospital data were obtained
from
Riksstroke. We used multivariable logistic
regression to analyze the association between reperfusion therapy and
patient education.
Results—A total of 3649 (4.2%) of the patients received reperfusion therapy. University-educated patients were more likely to be treated
(5.5%) than patients with secondary (4.6%) or primary education (3.6%; P<0.001).
The inequality associated with education was still present after
adjustment for patient characteristics; university
education odds ratio, 1.14; 95% confidence
interval, 1.03 to 1.26 and secondary education odds ratio, 1.08; 95%
confidence
interval, 1.00 to 1.17 compared with primary
education. Higher hospital specialization level was also associated with
higher
reperfusion levels (P<0.001). In
stratified multivariable analyses by hospital type, significant
treatment differences by education level existed
only among large nonuniversity hospitals
(university education odds ratio, 1.20; 95% confidence interval,
1.04–1.40; secondary
education odds ratio, 1.14; 95% confidence
interval, 1.01–1.29).
Conclusions—We
demonstrated a social stratification in reperfusion, partly explained by
patient characteristics and the local hospital
specialization level. Further studies should
address treatment delays, stroke knowledge, and means to improve
reperfusion
implementation in less specialized hospitals.
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