|| Checking for direct PDF access through Ovid
Background: Stroke is the most common cause of adult disability and the second most common cause of death in London, United Kingdom. Social deprivation has been demonstrated to be an important risk factor for stroke. It is unclear whether individuals from a lower socioeconomic background suffer more severe strokes. In this study we aim to investigate the relationship between social deprivation and stroke severity at presentation to hospital.Method: Data was prospectively collected on all patients presenting to a London tertiary stroke centre between 1st February 2014 and 1st March 2017. Stroke severity on presentation to the emergency department was measured by the National Institute of Health Stroke Scale (NIHSS). This data was linked using the patient’s zip code to the UK government’s published index of multiple deprivation decile (IMDD) - 1st decile being most deprived, 10th decile being least deprived. Univariate and multivariate regression analyses were performed to evaluate the association between social deprivation and stroke severity.Results: Data was available for all 2514 patients that presented between 1st February 2014 and 1st March 2017. The median IMDD was 3. There was an association with an increase in IMDD and increasing age at presentation (p<0.05 OR 1.48), decreasing prevalence of hypertension (p<0.05 OR 0.93) and decreasing prevalence of diabetes (p<0.05 OR 0.88). Adjusting for patient characteristics and time from onset of symptoms to presentation to hospital, there was an association with an increase in IMDD and lower NIHSS at presentation to hospital (p<0.05 OR 0.76).Conclusion: The patients that presented to our hospital during this study were more likely to be from a deprived area. Despite being younger, patients from more deprived areas were observed to have higher rates of hypertension and diabetes compared with patients from less deprived areas, and this should be the subject of targeted intervention in primary care. In our analyses, deprivation was associated with a more severe clinical presentation of stroke. This finding may contribute to worse outcomes following stroke in patients from more deprived areas, and the factors underlying this relationship should be investigated further.