Deprived of a good stroke outcome.

A lthough the decline in poststroke mortality is a cause for celebration, 1 we must remain mindful that substantial poststroke disability is considered a worse outcome than death for many people. 2 Thus, an increased focus on stroke survivors, in particular, their cognitive and physical function, is needed. Stroke survivors face many of the same challenges as cancer survivors, and perhaps stroke survivorship could be modeled after the ongoing extensive survivorship care and research done by our oncology colleagues. 3 In this issue of Stroke, Chen et al 4 used 16 years of data from the South London Stroke registry to explore the role of socioeconomic status (SES) and poststroke disability. In this well-done article, the authors found that SES was associated with 90-day and 3-year functional impairment as measured by the Barthel Index. When compared with the least deprived group of stroke survivors, the most deprived group of stroke survivors had over a 75% increase in the odds of poor functional outcome. This association remained after accounting for prominent predictors of poststroke disability, including age, stroke severity, and pre-morbid functional impairment. In stratified analysis, SES was associated with functional impairment in women, patients aged ≥65 years, patients without comorbidities, and patients with an ischemic stroke but not other groups. Glasgow Coma Score and speech deficit were used to adjust for stroke severity rather than a more comprehensive severity measure like the National Institutes of Health Stroke Scale score, and this may explain a part of their significant findings. Across many different health and disease conditions, lower SES, often in a gradated fashion, has been associated with poor outcomes. 5 Within stroke, there is a robust association between SES and stroke incidence and mortality, whereas the evidence for the association of SES and stroke severity is more complex. 6 Various measures of SES have been used in stroke research, including education, occupation, income/ wealth, material ownership, and geographic based measures, each of which considers a different aspect of SES. 7 The study of Chen et al 4 used an Index of Multiple Deprivation, which is based on the area of residence and is a composite measure of 38 indicators. Although this likely reflects home location attributes, such as the physical, social, or service environment, which are associated with an individual's health, it does not directly reflect the stroke survivors' individual SES. Research exploring poststroke disability is challenging. One concern is …