Association of Neighbourhood Deprivation with Secondary Prevention Prescribing and All-Cause Mortality among Stroke Patients in Scotland: A Population-Based Study.

Abstract

Introduction: Previous studies have shown that residing in more deprived neighbourhoods is associated with an increased risk for stroke and worse health outcomes. We aimed to investigate the association between neighbourhood deprivation and secondary prevention prescribing and all-cause mortality after a stroke in Scotland.

Methods: This retrospective observational study analysed linked data on first-ever stroke patients admitted to hospitals across Scotland between 1 January 2011 and 31 December 2018. Data were obtained from the Scottish Stroke Care Audit (SSCA), hospital admissions dataset, community prescribing and dispensing dataset, and mortality records. Neighbourhood deprivation was assessed using the Scottish Index of Multiple Deprivation (SIMD) quintiles. Study outcomes were 1-year all-cause mortality and secondary prevention prescribing, stratified by stroke type and presence of atrial fibrillation (AF). Findings from Cox regression and logistic regression analyses, with models adjusted for sociodemographic factors, comorbidity burden, stroke severity, and stroke unit admission, are presented.

Results: This study included 47,947 stroke patients, of which 11,752 (24.5%) resided in the most deprived areas (quintile 1) and 7,450 (15.6%) resided in the least deprived areas (quintile 5). Compared with patients from the most deprived areas, patients from the least deprived areas were older {78 (interquartile range [IQR] 68-84) vs. 71 (60-81) years}, experienced more intracerebral haemorrhages (12.1% vs. 9.2%), and more AF (26.5% vs. 20.4%). Among ischaemic stroke patients, residing in less deprived areas was associated with reduced hazard of all-cause mortality at 1 year (adjusted hazard ratio [aHR] 0.97; 95% confidence interval [CI], 0.96-0.99), reduced odds of antiplatelet prescription in patients without AF (adjusted odds ratio (aOR, 0.95; 95% CI, 0.92-0.98), and increased odds of being anticoagulated in patients with AF (aOR, 1.15; 95% CI, 1.09-1.20), compared to patients residing in the most deprived areas. No significant differences in all-cause mortality and secondary prevention prescribing by neighbourhood deprivation were found in intracerebral haemorrhage patients.

Conclusion: In this retrospective observational study, ischaemic stroke patients residing in the least deprived areas had a lower hazard of 1-year all-cause mortality, lower odds of antiplatelet prescription (in the absence of AF), but higher odds of oral anticoagulant prescription (in the presence of AF), compared to those residing in the most deprived areas. These findings suggest that neighbourhood deprivation is independently associated with all-cause mortality and treatment after stroke, highlighting potential interventions for stroke risk factors and poststroke care, particularly in patients from more deprived areas.