Socioeconomic status and health-related quality of life after stroke: a systematic review and meta-analysis

Yichao A Sun; Serah Kalpakavadi; Sarah Prior; Amanda G Thrift; Suzanne Waddingham; Hoang Phan; Seana L Gall

doi:10.1186/s12955-023-02194-y

Socioeconomic status and health-related quality of life after stroke: a systematic review and meta-analysis

Health Qual Life Outcomes. 2023 Oct 25;21(1):115. doi: 10.1186/s12955-023-02194-y.

Authors

Yichao A Sun¹, Serah Kalpakavadi¹, Sarah Prior², Amanda G Thrift³, Suzanne Waddingham⁴, Hoang Phan^{1

5}, Seana L Gall^{6

7}

Affiliations

¹ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia.
² Tasmanian School of Medicine, Rural Clinical School, University of Tasmania, Burnie, Australia.
³ Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
⁴ Tasmanian School of Medicine, University of Tasmania, Hobart, Australia.
⁵ Menzies School for Health Research, Charles Darwin University, Casuarina, Australia.
⁶ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS, 7000, Australia. seana.gall@utas.edu.au.
⁷ Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia. seana.gall@utas.edu.au.

Abstract

Background: Socioeconomic status (SES) is associated with stroke occurrence and survival following stroke but its association with health-related quality of life (HRQoL) following stroke remains uncertain. We performed a systematic review and meta-analysis to examine the association between SES and HRQoL after stroke.

Methods: PubMed, SCOPUS, EMBASE, and Web of Science were searched to identify relevant cohort and case-control studies between January 2000 and May 2022. Two authors screened titles, abstracts and full text articles. One author extracted data from all included studies. Meta-analyses were performed for studies with comparable measurements of SES and HRQoL. Random effects models were used to estimate pooled summary standardised mean differences in HRQoL by SES.

Results: Out of 1,876 citations, 39 studies incorporated measurement of overall HRQoL following stroke and were included in the systematic review, with 17 studies included in the meta-analyses. Overall, reports including education, income, occupation and work status effects on HRQoL after stroke were inconsistent among all included 39 studies. In the global meta-analysis of 17 studies, HRQoL among survivors of stroke was lower in the low SES group than in the high SES group (standardised mean difference (SMD) -0.36, 95% CI -0.52, -0.20, p < 0.0001). When using education and income indicators separately, summary effects were similar to those of the global analysis (low versus high education SMD -0.38, 95% CI -0.57, -0.18, p < 0.0001; low versus high income SMD -0.39, 95% CI -0.59, -0.19, p < 0.0001).

Conclusions: Across all SES indicators, people with stroke who have lower SES have poorer overall HRQoL than those with higher SES. Accessibility and affordability of poststroke support services should be taken into consideration when planning and delivering services to people with low SES.

Keywords: Education; Health-related quality of life; Income; Inequity; Socioeconomic status; Stroke; Systematic review.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Humans
Income
Occupations
Quality of Life*
Social Class
Stroke*