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Socioeconomic variations in the course of stroke: unequal health outcomes, equal care?
  1. G A M van den Bos1,
  2. J P J M Smits2,
  3. G P Westert2,
  4. A van Straten3
  1. 1National Institute of Public Health and the Environment, Department for Health Services Research and Academic Medical Centre, Department for Social Medicine, Netherlands
  2. 2National Institute of Public Health and the Environment, Department for Health Services Research, Netherlands
  3. 3Netherlands Institute of Mental Health and Addiction, Netherlands
  1. Correspondence to:
 Professor G A M van den Bos, National Institute of Public Health and the Environment, Department for Health Services Research, PO Box 1, 3720 BA Bilthoven, Netherlands;


Study objective: The aim of this paper is to quantify the socioeconomic gap in long term health outcomes after stroke and related health care utilisation, in order to evaluate whether those in need of care do actually receive appropriate levels of care.

Design: Stroke patients from the lower socioeconomic group were compared with stroke patients from the higher socioeconomic group with respect to sociodemographic and clinical characteristics, health outcomes, and related health care utilisation.

Setting: Patients were recruited from admissions to 23 randomly selected hospitals in the Netherlands.

Patients: 465 patients were included who had had a stroke six months earlier and were followed up three years and five years after stroke.

Main results: The observed odds ratios suggest that patients from the lower socioeconomic group experienced more disabilities up to three years after stroke and more handicaps up to five years after stroke. After adjusting for health care needs there were no significant associations between socioeconomic status and health care utilisation. The observed figures, however, suggest that a lower socioeconomic status tended to increase admission to nursing homes and to decrease receiving care in non-institutional settings.

Conclusions: Overall, inequalities in long term health outcomes were observed but solid indications for large inequalities in health care utilisation were not found. More investments in coordinated stroke services are needed to alleviate the unfavourable health situation of disadvantaged groups and to ensure that health care services respond appropriately to the health care needs of different socioeconomic groups.

  • stroke
  • health care
  • socioeconomic inequality

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  • Funding: ROSA was supported by grants from the Dutch Organisation for Scientific Research, the Netherlands Heart Foundation and the Dutch Fund for Investigative Medicine of the Health Insurance Council.

  • Conflicts of interest: none.