Ethnic disparities in health-related quality of life and cognitive function after stroke in the Netherlands
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Background/objective
Various studies have demonstrated, European data regarding ethnic disparities in health-related quality of life (HRQOL) after stroke is scarce and none used patient reported outcomes measurements (PROMs). This study explores whether ethnicity predict HRQOL using PROMs and cognitive function after stroke in the Netherlands.
Patients and methods
Patients admitted to the hospital with a first ever stroke were included. Outcome assessments included the Patient Reported Outcomes Measurement Information System (PROMIS) Profile and EuroQoL-5D (EQ-5D index and EQ-5D-L Visual Analogue Scale, VAS) for HRQOL and the PROMIS Cognitive Function for cognitive functioning. Measurements were done at hospital admission and after 3 and 12 months (EQ-5D-3L and EQ-VAS only at 12 months). Ethnicity (migration background yes/no), other demographics and stroke characteristics were collected at admission. Outcomes were compared between patients with and without a migration background by a multivariate linear mixed-effects model, adjusted for age, sex, education level and severity of stroke (NIHSS at admission).
Results
262 patients were included, of whom 74 (28.2%) did and 188 (71.8%) did not have a migration background. A significant difference was observed at admission for the physical function score (estimate=3.30, SE=1.25, p=0.01), at three months for anxiety score (estimate=-2.95, SE=1.48, p=0.05) and twelve months for sleep disturbance score (estimate=-5.43, SE=1.61, p<0.01). These results are all to the disadvantage of patients with a migration background. The EQ-5D index and EQ-5D VAS at twelve months follow-up was significantly lower in patients with a migration background compared to patients without a migration background (respectively adjusted B −0.09 (95% CI −0.17; −0.01)) and adjusted B −7.27 (95% CI (−13.99; −0.56)).
Conclusion
Up to twelve months after hospital admission, stroke patients with a migration background had significantly worse scores regarding several domains of HRQOL compared to patients without a migration background.
