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A comparison of outcome for stroke patients in Barbados and South London
Nigel C Smeeton1, David O C Corbin, Anselm J M Hennis
1Division of Health and Social Care Research, King's College London, London, UK. nigel.smeeton@kcl.ac.uk
Insights
Stroke patients in Barbados showed higher short-term social activity and less institutional care compared to London. However, Barbados patients faced a higher early mortality risk, with similar long-term survival after the initial four weeks.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Limited understanding of post-stroke outcomes in Caribbean populations.
- Need to compare stroke patient outcomes between Barbados and London.
Purpose of the Study:
- To investigate differences in activities of daily living (ADL), social activities, living circumstances, and survival rates for stroke patients in Barbados versus London.
- To identify factors influencing post-stroke recovery and outcomes in diverse populations.
Main Methods:
- Utilized data from the South London Stroke Register and Barbados Register of Strokes (2001-2004).
- Assessed ADL using the Barthel Index and social activities using the Frenchay Activities Index.
- Analyzed living circumstances, mortality, and dependency at 3 months, 1 year, and 2 years using logistic regression, adjusting for covariates.
Main Results:
- Barbados patients had higher social activity (OR 1.84) and were less likely to be in institutional care (RRR 0.38) at 3 months.
- No significant differences in ADL were observed at 3 months.
- Barbados patients exhibited a higher risk of mortality at 3 months (RRR 1.85), 1 year (RRR 1.83), and 2 years (RRR 1.82), primarily due to early deaths.
Conclusions:
- Evidence of a 'healthy survivor effect' in Barbados, with greater short-term social activity.
- Post-stroke survival rates were similar in both settings for patients surviving the initial four weeks.
- Highlights the importance of considering population-specific factors in stroke care and outcomes.
Background And Aims:
Little is known about the poststroke outcome in Caribbean populations. We investigated differences in the activities of daily living, level of social activities, living circumstances and survival for stroke patients in Barbados and London.
Methods:
Data were collected from the South London Stroke Register and the Barbados Register of Strokes for patients with a first-ever stroke registered between January 2001 and December 2004. The ability to perform activities of daily living was measured by the Barthel Index and level of social activities by the Frenchay Activities Index. Living circumstances were categorised into private household vs. institutional care. Death and dependency, activities of daily living and social activities were assessed at three-months, one- and two-years using logistic regression, adjusted for differences in demographic, socioeconomic and stroke severity characteristics.
Results:
At three-months, a high level of social activities was more likely for the Barbados Register of Strokes (odds ratio 1.84; 95% confidence interval 1.03-3.29); there were no differences in activities of daily living; and Barbados Register of Strokes patients were less likely to be in institutional care (relative risk ratio 0.38; 95% confidence interval 0.18-0.79). Following adjustment, Barbados Register of Strokes patients had a higher risk of mortality at three-months (relative risk ratio 1.85; 95% confidence interval 1.03-3.30), one-year (relative risk ratio 1.83; 95% confidence interval 1.08-3.09) and two-years (relative risk ratio 1.82; 95% confidence interval 1.08-3.07). This difference was due to early poststroke deaths; for patients alive at four-weeks poststroke, survival thereafter was similar in both settings.
Conclusions:
In Barbados, there was evidence for a healthy survivor effect, and short-term social activity was greater than that in the South London Stroke Register.
