Relationship between level of education and one-year survival after ischaemic stroke
*Correspondencia: Dra. Adela Olascoaga Arrate. Departamento de Salud del Gobierno Vasco. Alameda de Rekalde, 39A. E-48008 Bilbao.
E-mail: aolascoaga@euskadi.eus
Introduction: The relationship between socioeconomic status and incidence or stroke mortality rates is well established. The evidence of an association between this variable and survival is less conclusive. Level of education is a widely-used measure of socioeconomic status in elderly people.
Aim: To assess the relationship between one-year survival after stroke and level of education.
Patients and methods: We analysed data on 544 consecutively recruited patients admitted for acute ischaemic stroke in one the public hospitals of Bizkaia (Spain). Data were obtained through interviews with patients or accompanying persons and from medical records. We studied variables concerning previous functional status, stroke severity, cardiovascular risk factors and stroke care provided. Patients were followed up for 12 months and the dates of any deaths were recorded. Univariate and multivariate analyses were carried out to assess the relationship between level of education and survival.
Results: A total of 203 (86%) women and 273 (88.6%) men were alive at 12 months. In both sexes, individuals with a lower level of education had poorer previous functional status, more severe strokes and higher mortality rates. In the multivariate analysis, the association between level of education and survival remained significant in the adjusted model in men.
Conclusions: In our setting, there are differences in the survival of patients with ischaemic stroke as a function of level of education. The impact of this factor was greater in men than women.
Objetivo Estudiar la relación de la supervivencia en el primer año tras el ictus con el nivel de estudios.
Pacientes y métodos Se analizaron los datos de 544 pacientes con ictus isquémico agudo ingresados en los hospitales públicos de Bizkaia (España), seleccionados consecutivamente. Se obtuvieron datos por entrevista a pacientes o acompañantes y de historia clínica. Se estudiaron variables sobre situación funcional previa, gravedad del ictus, factores de riesgo cardiovascular y de atención al ictus. Se hizo un seguimiento de 12 meses para registrar, en su caso, la fecha de fallecimiento. Se realizó un análisis univariado y multivariado para identificar la relación del nivel de estudios con la supervivencia.
Resultados Tras 12 meses, sobrevivían 203 mujeres (86%) y 273 hombres (88,6%). En ambos sexos, las personas con menos estudios tuvieron peor situación funcional previa, mayor gravedad y fallecieron en mayor proporción. En el análisis multivariado, el nivel de estudios se mantuvo asociado con la supervivencia en el modelo ajustado para los hombres.
Conclusiones La diversidad de nivel educativo marca diferencias en la supervivencia de los pacientes con ictus isquémico en nuestro entorno. El impacto de este factor fue mayor en los hombres que en las mujeres.