High socioeconomic status is associated with stroke severity among stroke patients in the National Brain Centre Hospital, Jakarta, Indonesia

Abstract

Rapid economic growth has widened the gap between the rich and the poor, contributing to inequalities in socioeconomic status (SES) in Indonesia and possibly inequalities in health care. Here, we aimed to assess the potential association between SES and stroke severity in Indonesia, one of the largest low- and middle-income countries. Patients diagnosed with stroke at National Brain Centre (NBC) Hospital, Jakarta, Indonesia, in 2020 were included in the study. SES was measured based on marital status, occupation, education level, source of payment, and hospitalized class with smoking status and sex as confounder. Stroke severity was classified based on the National Institutes of Health Stroke Scale score into minor stroke (Adams et al., 1993; Amarenco et al., 2014; Andersen and Olsen, 2018; Austin and Steyerberg, 2017) and moderate to severe stroke (>4).A total of 2,443 patients with moderate to severe stroke (58%) were analyzed. Currently employed patients had a lower adjusted OR (aOR) of 0.65 (95% confidence interval [CI], 0.51–0.83) than unemployed patients. Patients with the highest education level, at least a diploma degree, had a lower aOR of 0.67 (95% CI, 0.49–0.92) than those with an elementary or no education. Our findings showed that patients with a higher SES had a lower risk of more severe stroke than those with a lower SES. Hence, we must focus on improving SES as part of stroke management.

Keywords

• Stroke severity
• Socioeconomic status (SES)
• Education level
• Employment status