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Socioeconomic inequities in mortality and functional outcome after stroke in Zanzibar: A prospective cohort study

Lookup NU author(s): Professor Richard Walker



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2023 The AuthorsObjectives: To characterise mortality and functional outcome and their relationships with socioeconomic deprivation for women and men in Zanzibar. Materials and methods: Participants in ZanStroke, a prospective observational study of patients admitted to hospital with a diagnosis of acute stroke, were followed up until one year after the stroke. The modified National Institute of Health Stroke Scale was used to assess initial stroke severity, while modified Rankin Scale (mRS) was used to assess disability at 12 months post-stroke. A multidimensional poverty index was created using individual-level data. Kaplan-Meier analysis and Cox regression model were used to examine associations of socioeconomic deprivation and death at 28 days and 12 months after stroke onset, while logistic regression analysis was used to examine associations between deprivation and functional outcome. Results: Overall mortality rate was 38.2% (CI 34.8-41.9) at 28 days, rising to 59.0% (CI 55.2-62.8) at 12 months. When adjusted for other variables, survival was higher among the least deprived (HR 0.60 CI 0.45-0.80), an association that was strongly significant for women (HR 0.46 CI 0.29-0.74). Among 12-month survivors 45.1% (n = 122) had no/low level of disability (mRS 0-2), while 22.9% (n = 62) were unable to walk independently or at all. No difference between socioeconomic deprivation and outcome was seen at one year. Conclusion: Case-fatality rates were high, and socioeconomic disparities were evident even during the acute stroke phase. Policies are needed to reduce significant health disparities, adapt evidence-based interventions, and promote equitable access to stroke care and rehabilitation.

Publication metadata

Author(s): Jorgensen JMA, Nielsen KK, Petersen JH, Sadiq HS, Kelly ZF, Walker RW, Christensen DL

Publication type: Article

Publication status: Published

Journal: Journal of Stroke and Cerebrovascular Diseases

Year: 2023

Volume: 32

Issue: 5

Print publication date: 01/05/2023

Online publication date: 15/03/2023

Acceptance date: 06/03/2023

Date deposited: 30/03/2023

ISSN (print): 1052-3057

ISSN (electronic): 1532-8511

Publisher: W.B. Saunders


DOI: 10.1016/j.jstrokecerebrovasdis.2023.107081


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