Stroke outcomes in a socio-economically disadvantaged urban community
Methods. Stroke patients were recruited from a district hospital in Cape Town and followed-up for 6 months. Clinical characteristics, demographic and socioeconomic data, and disability and function as measured by modified Rankin Score (mRS), modified Barthel Index (mBI) at recruitment and 3 follow-up visits, were recorded.
Results. The study included 196 patients. Median age was 60 (IQR 51 - 69) years, 135 (68.9%) were female, 57.7% black, 42.3% coloured, and 45 (23%) died within 6 months. At discharge, median mBI score was 7 (IQR 3 - 12) and median mRS 4 (IQR 3 - 5). In the multivariate regression models, only function (mBI OR 0.88, 95% confidence interval (CI) 0.79 - 0.96, p<0.0001) and disability (mRS 0R 2.34, 95%CI 1.20 - 4.54, p<0.0001) were independently associated with risk of death. Shack housing was independently associated with moderate or severe disability (odds ratio 3.42, 95%CI 1.22 - 9.59, p=0.02). Despite limited rehabilitation resources, 67% of survivors had mild to moderate disability at 6 months.
Conclusion. Apart from initial stroke severity, risk factors for poor survival were a severe disability category and the presence of impaired swallowing at discharge. Shack housing was independently associated with poor functional outcomes. These findings should be helpful in allocating home-based care and inpatient rehabilitation resources to high-risk groups to improve outcomes.
Linda de Villiers, University of Cape Town
Motasim Badri, Department of Medicine. University of Cape Town
Monica Ferreira, University of Cape Town
Alan Bryer, University of Cape Town
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Date published: 2011-05-06
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