Verschillen in preventieve zorg door huisartsen verklaren sociaal-economische verschillen in de incidentie van CVA niet.

Abstract

Objective: To assess socioeconomic disparities in stroke incidence and in the quality of preventive care in general practice for stroke in the Netherlands. Study design and setting A total of 190,664 patients who registered in 96 general practices were followed up for 12 months. Data were collected on diagnoses, referrals, prescriptions, and diagnostic procedures. Hazard ratios (HR) were calculated to assess the association between educational level and stroke incidence. We developed quality indicators based on evidence based guidelines for stroke prevention at general practice, and assessed deviations from these guidelines. Multilevel logistic regression was used to assess socioeconomic disparities in the quality of preventive care for stroke precursors. Results: Lower educational level was associated with higher incidence of stroke in men (HR 1.36, 95% CI 1.06-1.74) but not in women. Among both men and women, there were socioeconomic disparities in the prevalence of hypertension, hypercholesterolemia, diabetes, angina pectoris, heart failure, and peripheral artery disease. Lower educated hypercholesterolemia patients under medication were less likely to be prescribed statins (odds ratio 0.62, 95% CI 0.42-0.91). However, for other precursors of stroke, there were no major disparities in the quality of preventive care. Conclusion: There are socioeconomic disparities in stroke incidence among men but not among women. Socioeconomic differences in factors such as hypertension and diabetes are likely to contribute to stroke disparities. Universal access to general practice and the implementation of general practice guidelines in the Netherlands are likely to have promoted the provision of equal and standardised care for stroke precursors across socioeconomic groups