People are more likely to die within a year of having a stroke if they live in more deprived areas, according to researchers based at the University of Aberdeen. 

The research was funded by Chest Heart & Stroke Scotland (CHSS) and the article was published in June in Cerebrovascular Diseases. The article’s four authors analysed data from almost 50,000 patients recorded in the Scottish Stroke Care Audit.

The paper’s first author is Kadie-Ann Sterling, a research assistant from the University’s Institute of Applied Health Sciences. She and her colleagues looked at multiple outcomes after stroke including death from any cause within a year and prescriptions given for medication known to prevent recurrent stroke.

Ms Sterling and her colleagues investigated whether these outcomes were impacted by the patients’ ‘neighbourhood deprivation score’, measured by the Scottish Index of Multiple Deprivation.

Results showed that stroke patients from the most deprived areas were more likely to die from any cause within a year of the stroke than those in the least deprived areas. 

Also, patients living in the most deprived areas were younger and had more co-existing health conditions than those in the least deprived areas at the time of their stroke. 

The treatment patients received also differed according to where they lived. The researchers explain that after an ischaemic stroke, which is caused by a blood clot in the brain, aspirin-like drugs are recommended to stop recurrence.

Key findings

•       those living in most deprived areas more likely to die in the year following a stroke

•       stroke patients from more deprived areas are younger and have more co-existing health conditions 

•      need for targeted public health and treatment interventions 

Public health implications

However, if the patient has atrial fibrillation (AF), a type of heart rhythm problem where the heartbeat is irregular, blood thinners called anticoagulants are given as they have been shown to reduce the risk of another stroke in these AF patients.

This analysis showed that, compared to more affluent areas, patients in more deprived areas were significantly less likely to be appropriately treated with recommended blood thinners if they had AF and more likely to be given aspirin-like drugs. 

Ms Sterling and her co-authors suggest that the reasons for this disparity in treatment might be differences in awareness of stroke risks factors and the benefits of treatment as well as better general health in more affluent stroke survivors.  However, even after taking stroke severity, access to stroke care and co-existing conditions into consideration, there was still a difference in death rates between affluent and deprived areas, suggesting there is a need for further work to understand this.  

‘Our findings suggest that a national approach to stroke prevention and best stroke management may need to be adapted to take into account these disparities and focus on different approaches for more deprived neighbourhood areas’ [Mary Joan MacLeod]

The team suggests that their findings should be considered when developing public health messaging and policy, with a view to tailoring advice and subsequent treatment according to where people live.

Ms Sterling said: ‘Our findings suggest that there were significant differences in stroke presentation, secondary prevention prescribing and mortality outcomes across different areas in Scotland and this was dependent upon the deprivation within each area.

‘Understanding the differences in stroke presentation and outcomes between different neighbourhoods should influence public health education, decisions around screening for cardiovascular risk factors and should also be a factor when considering more focussed longer-term follow-up in the most vulnerable patients.’

Co-author Mary Joan MacLeod is chair in clinical medicine at the University of Aberdeen and an honorary consultant at NHS Grampian.

Professor MacLeod noted: ‘Our findings suggest that a national approach to stroke prevention and best stroke management may need to be adapted to take into account these disparities and focus on different approaches for more deprived neighbourhood areas.’

Stroke care is ‘not equal’

Jane-Claire Judson, chief executive of CHSS, which funded the research, said: ‘The study confirms what we see every day in communities across Scotland – stroke care is not equal, and that’s unacceptable. 

‘The worrying trend that people living in more deprived areas are more likely to die within a year of a stroke and less likely to receive the right treatment or consistent care is both alarming and unjust.

‘These research outcomes amplify the need for a substantial rethink of how health services are delivered in Scotland. The postcode lottery for treatment and care must end.

Ms Judson added: ‘At CHSS, we’re already working in communities to deliver prevention, support recovery, and enable people to self-manage their condition. But we can’t do it alone. 

‘We’re calling on the Scottish Government and NHS to act now. We need a proactive approach to transforming healthcare services, and CHSS stands ready to help drive forward a fairer and more effective stroke care system for everyone in Scotland.’

To access the full version of the article – titled Association of Neighbourhood Deprivation with Secondary Prevention Prescribing and All-Cause Mortality among Stroke Patients in Scotland: A Population-Based Study – see: https://karger.com/ced/article/doi/10.1159/000546261/926743/Association-of-neighbourhood-deprivation-with

To find out more about Chest & Stroke Scotland, see: chss.org.uk/

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