Are there inequalities in the provision of stroke care? Analysis of an inner-city stroke register

Background and Purpose - There is evidence of unequal access to health care interventions even where universal health systems operate. We investigated associations between patients' sociodemographic characteristics and the provision of acute and longer-term stroke care in a multiethnic urban population. Methods - We used data from 1635 patients with first-ever stroke, collected by a population-based stroke register from 1995 to 2000. Using multivariable analyses, controlled for sociodemographic and clinical factors, we investigated access to 22 evidence-based components of care. Results - 1392 patients (85.1%) were admitted to hospital; of these, 354 (25.4%) were admitted or transferred to a stroke unit. Of those with clinical need, 607 (70.7%) received physical therapies; 477 (59.8%) received speech and language therapy. Older age was associated with lower odds of hospitalization ( odds ratio [ OR], 0.50; 95% CI, 0.32 to 0.77, P = 0.02) and diagnostic brain imaging ( OR, 0.15; 95% CI, 0.08 to 0.30, P < 0.01) but higher odds of receiving physical therapy ( OR, 4.24; 95% CI, 1.22 to 14.73, P < 0.01). Black ethnicity was associated with higher odds of stroke unit admission ( OR, 1.59; 95% CI, 1.01 to 2.49, P < 0.04). There was a weak association between socioeconomic status and admission to hospital and stroke unit. Gender was associated only with treatment of hypertension before stroke. Conclusions - Provision of individual components of care over 1 year varied for specific sociodemographic categories, but there was no consistent pattern of inequality. Clinical decision-making processes are likely to influence these patterns. Further information about clinician and patient roles in decision making is required.