Universal health care cuts stroke inequalities

A person's risk of having a stroke or dying from a stroke varies by social and economic status. Men and women who are less economically and socially advantaged are at increased risk relative to their better-off and more socially connected counterparts.

But new research from Italy hints that a universal health care system may equalize some of this disparity.

A health care system can worsen or reduce inequalities in health caused in part by social and economic status, Giulia Cesaroni, epidemiologist at the Local Health Authority in Rome, explained in an email to Reuters Health.

Cesaroni and colleagues found that Italy's universal health care system seems to reduce inequalities in stroke among less and more privileged individuals.

Cesaroni's team looked at strokes and deaths from stroke between 2001 and 2004 in 10,033 men and women who were 35 to 84 years old. During this period, 7,507 people suffered a first stroke.

About 23 percent of these strokes occurred in very underprivileged people. As social/economic status increased, the incidence of stroke decreased to the point that about 17 percent of strokes occurred among men and women with the highest social/economic status, the team found.

However, once stroke patients were hospitalized, rates of death within 30 days and 1 year after having a stroke were generally lower among less privileged versus more privileged men and women.

For example, risk of death within 30 days was about 20 percent lower among privileged men with a bleeding-type stroke and women with a blockage-type stroke. It was about equal in less and more privileged women with bleeding-type stroke, but was about 20 percent higher in less privileged men with a stroke caused by a blocked artery.

When Cesaroni's group looked at re-hospitalisation for a subsequent stroke or for heart disease after 1 year, they found rates significantly higher among less privileged, versus more privileged, patients.

The investigators conclude, therefore, that "tackling health inequalities in stroke should focus on primary prevention in underprivileged groups of the population."

SOURCE: Stroke, August 2009.