Background: Health-related quality of life (HRQoL) after stroke is an important patient reported outcome. This study aimed to investigate the association between socio-economic status (SES) and HRQoL after first-ever stroke.
Methods: The Admitted Patient Care Episode (APC) and the Death Registry of Tasmania were used to identify first-ever stroke cases. The Australian Stroke Clinical Registry (AuSCR) was used to obtain stroke severity, processes of care (stroke unit, discharge on anti-hypertensive and discharge care plan) and HRQoL. The AuSCR monitors stroke care from the hospitals and self-reported outcomes at 90-180-day follow-up. The Emergency Department data and the APC were used to obtain comorbidities. SES was determined by the Index of Relative Socio-economic Advantage and Disadvantage from the Socio-Economic Indexes for Areas 2016 by quintile (high, medium-high, medium, low-medium, low), and, remoteness, by the Accessibility and Remoteness Index of Australia. HRQoL was measured by EQ-5D (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) three level scale, utility index and visual analogue scale (VAS). Tobit regression and generalised linear regression models were constructed to estimate the associations between SES and EQ-5D utility index and the VAS score.
Results: Between 2015 and 2019, 1051 cases were identified. The mean utility index and the VAS score were 0.68 (SD, 0.33) and 68.10 (SD, 21.32). Usual activity was the most frequently (58%) reported issue. Compared to the high SES group, the low SES group had 0.07 (95% CI -0.14, -0.001) lower in utility score after adjusting for age, sex, remoteness, comorbidities and processes of care. Individuals with low SES were also showed lower VAS score (β -3.10, 95% CI -6.94, 0.74).
Conclusion: Stroke survivors in low SES group are more likely to report a lower HRQoL. Multifaceted approach that includes access to support services and patient education should be taken into consideration when delivering services.