Socioeconomic gap between neighborhoods of Budapest: Striking impact on stroke and possible explanations

Ildikó Szőcs, D. Bereczki, András Ajtay, Ferenc Oberfrank, Ildikó Vastagh

Research output: Contribution to journalArticle

Abstract

Introduction Hungary has a single payer health insurance system offering free healthcare for acute cerebrovascular disorders. Within the capital, Budapest, however there are considerable microregional socioeconomic differences. We hypothesized that socioeconomic deprivation reflects in less favorable stroke characteristics despite universal access to care. Methods From the database of the National Health Insurance Fund, we identified 4779 patients hospitalized between 2002 and 2007 for acute cerebrovascular disease (hereafter ACV, i.e. ischemic stroke, intracerebral hemorrhage, or transient ischemia), among residents of the poorest (District 8, n = 2618) and the wealthiest (District 12, n = 2161) neighborhoods of Budapest. Follow-up was until March 2013. Results Mean age at onset of ACV was 70±12 and 74±12 years for District 8 and 12 (p<0.01). Age-standardized incidence was higher in District 8 than in District 12 (680/100,000/year versus 518/100,000/year for ACV and 486/100,000/year versus 259/100,000/year for ischemic stroke). Age-standardized mortality of ACV overall and of ischemic stroke specifically was 157/100,000/year versus 100/100,000/year and 122/100,000/year versus 75/100,000/year for District 8 and 12. Long-term case fatality (at 1,5, and 10 years) for ACV and for ischemic stroke was higher in younger District 8 residents (41–70 years of age at the index event) compared to D12 residents of the same age. This gap between the districts increased with the length of follow-up. Of the risk diseases the prevalence of hypertension and diabetes was higher in District 8 than in District 12 (75% versus 66%, p<0.001; and 26% versus 16%, p<0.001). Discussion Despite universal healthcare coverage, the disadvantaged district has higher ACV incidence and mortality than the wealthier neighborhood. This difference affects primarily the younger age groups. Long-term follow-up data suggest that inequity in institutional rehabilitation and home-care should be investigated and improved in disadvantaged neighborhoods.

Original languageEnglish
Article numbere0212519
JournalPloS one
Volume14
Issue number2
DOIs
Publication statusPublished - Feb 1 2019

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Health insurance
stroke
socioeconomics
Stroke
Cerebrovascular Disorders
Medical problems
Patient rehabilitation
cerebrovascular disorders
health insurance
Vulnerable Populations
health services
Universal Coverage
Delivery of Health Care
low-income neighborhoods
Mortality
Hungary
Incidence
Cerebral Hemorrhage
National Health Programs
incidence

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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Socioeconomic gap between neighborhoods of Budapest : Striking impact on stroke and possible explanations. / Szőcs, Ildikó; Bereczki, D.; Ajtay, András; Oberfrank, Ferenc; Vastagh, Ildikó.

In: PloS one, Vol. 14, No. 2, e0212519, 01.02.2019.

Research output: Contribution to journalArticle

Szőcs, Ildikó ; Bereczki, D. ; Ajtay, András ; Oberfrank, Ferenc ; Vastagh, Ildikó. / Socioeconomic gap between neighborhoods of Budapest : Striking impact on stroke and possible explanations. In: PloS one. 2019 ; Vol. 14, No. 2.
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abstract = "Introduction Hungary has a single payer health insurance system offering free healthcare for acute cerebrovascular disorders. Within the capital, Budapest, however there are considerable microregional socioeconomic differences. We hypothesized that socioeconomic deprivation reflects in less favorable stroke characteristics despite universal access to care. Methods From the database of the National Health Insurance Fund, we identified 4779 patients hospitalized between 2002 and 2007 for acute cerebrovascular disease (hereafter ACV, i.e. ischemic stroke, intracerebral hemorrhage, or transient ischemia), among residents of the poorest (District 8, n = 2618) and the wealthiest (District 12, n = 2161) neighborhoods of Budapest. Follow-up was until March 2013. Results Mean age at onset of ACV was 70±12 and 74±12 years for District 8 and 12 (p<0.01). Age-standardized incidence was higher in District 8 than in District 12 (680/100,000/year versus 518/100,000/year for ACV and 486/100,000/year versus 259/100,000/year for ischemic stroke). Age-standardized mortality of ACV overall and of ischemic stroke specifically was 157/100,000/year versus 100/100,000/year and 122/100,000/year versus 75/100,000/year for District 8 and 12. Long-term case fatality (at 1,5, and 10 years) for ACV and for ischemic stroke was higher in younger District 8 residents (41–70 years of age at the index event) compared to D12 residents of the same age. This gap between the districts increased with the length of follow-up. Of the risk diseases the prevalence of hypertension and diabetes was higher in District 8 than in District 12 (75{\%} versus 66{\%}, p<0.001; and 26{\%} versus 16{\%}, p<0.001). Discussion Despite universal healthcare coverage, the disadvantaged district has higher ACV incidence and mortality than the wealthier neighborhood. This difference affects primarily the younger age groups. Long-term follow-up data suggest that inequity in institutional rehabilitation and home-care should be investigated and improved in disadvantaged neighborhoods.",
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