Tabla I. Variables clínicas y sociodemográficas (totales y por sexo). |
|||||
Total |
Mujeres |
Hombres |
p |
||
Fallecidos a los 12 meses |
68 (12,5%) |
33 (14%) |
35 (11,4%) |
NS |
|
Edad, mediana (p25-p75) |
75 (66-83) |
80 (71-85) |
73 (62-80) |
< 0,001 |
|
Nivel de estudios |
Sin estudios |
62 (11,4%) |
37 (15,7%) |
25 (8,1%) |
< 0,001 |
Primarios |
315 (57,9%) |
157 (66,5%) |
158 (51,3%) |
||
Secundarios + superiores |
167 (30,7%) |
42 (17,8%) |
125 (40,6%) |
||
Capacidad funcional previa (mRS) |
0-1 |
425 (78,1%) |
167 (70,8%) |
258 (83,8%) |
< 0,001 |
2-5 |
119 (21,9%) |
69 (29,2%) |
50 (16,2%) |
||
NIHSS, mediana (p25-p75) |
3 (1-8) |
4 (1-8) |
2,5 (1-7) |
0,03 |
|
Antecedentes de infarto cerebral o ICT |
131 (24,1%) |
57 (24,2%) |
74 (24,0%) |
NS |
|
Factores de riesgo cardiovascular |
Fibrilación auricular |
111 (20,4%) |
57 (24,2%) |
54 (17,5%) |
0,06 |
Cardiopatía isquémica |
85 (15,6%) |
30 (12,7%) |
55 (17,9%) |
NS |
|
Diabetes mellitus |
147 (27%) |
57 (24,2%) |
90 (29,2%) |
NS |
|
Hipertensión arterial |
374 (68,8%) |
162 (68,6%) |
212 (68,8%) |
NS |
|
Dislipidemia |
270 (49,6%) |
116 (49,2%) |
154 (50%) |
NS |
|
Tabaquismo |
102 (18,8%) |
24 (10,2%) |
78 (25,3%) |
< 0,001 |
|
Síntomas-imagen ≤ 90 min |
337 (61,9%) |
139 (58,9%) |
198 (64,3%) |
NS |
|
Ingreso en la unidad de ictus |
326 (59,9%) |
131 (55,5%) |
195 (63,3%) |
0,04 |
|
Recanalización |
90 (16,5%) |
40 (16,9%) |
50 (16,2%) |
NS |
|
ICT: isquemia cerebral transitoria; mRS: escala de capacidad funcional de Rankin modificada (mRS ≥ 2: discapacidad moderada, moderadamente grave o grave); NIHSS: escala de gravedad del ictus del National Institute of Health; NS: no significativo. |
Tabla II. Fallecimientos a los 12 meses y características en función del nivel de estudios. |
|||||||||
Hombres |
Mujeres |
||||||||
Sin estudios |
Primarios |
Secundarios o |
p |
Sin estudios |
Primarios |
Secundarios o |
p |
||
Fallecidos a los 12 meses |
40% |
14,6% |
1,6% |
< 0,001 |
18,9% |
15,9% |
2,4% |
0,05 |
|
Edad, mediana (p25-p75) |
80 (73-84) |
75 (67-82) |
66 (56-74) |
< 0,001 |
85 (77-89) |
80 (74-85) |
68 (55-78) |
< 0,001 |
|
mRS previo = 2 |
44% |
16,4% |
10,4% |
< 0,001 |
56,8% |
28,7% |
7,1% |
< 0,001 |
|
NIHSS mediana (p25-p75) |
5 (1,5-14) |
3 (1-8) |
2 (0-5) |
0,002 |
4 (1,5-7) |
4 (1-9,5) |
2 (1-7,5) |
NS |
|
Antecedentes de infarto cerebral o ICT |
24% |
23,4% |
24,8% |
NS |
29,7% |
25,5% |
14,3% |
NS |
|
Factores de riesgo cardiovascular |
Fibrilación auricular |
16% |
19% |
16% |
NS |
32,4% |
24,8% |
14,3 |
NS |
Cardiopatía isquémica |
20% |
19,6% |
15,2% |
NS |
16,2% |
15,3% |
0% |
0,02 |
|
Diabetes mellitus |
40% |
31% |
24,8% |
NS |
32,4% |
25,5% |
11,9% |
0,08 |
|
Hipertensión arterial |
76% |
69,6% |
66,4% |
NS |
70,3% |
72,6% |
52,4% |
0,04 |
|
Dislipidemia |
44% |
50% |
51,2% |
NS |
48,6% |
51,6% |
40,5% |
NS |
|
Tabaquismo |
20% |
25,3% |
26,4% |
NS |
5,4% |
7% |
26,2% |
0,001 |
|
Síntomas-imagen = 90 min |
64% |
66,5% |
61,6% |
NS |
48,6% |
59,2% |
66,7% |
NS |
|
Ingreso en la unidad de ictus |
68% |
60,1% |
66,4% |
NS |
27% |
58,6% |
69% |
< 0,001 |
|
Recanalización |
12% |
17,7% |
15,2% |
NS |
5,4% |
18,5% |
21,4% |
NS |
|
ICT: isquemia cerebral transitoria; mRS: escala de capacidad funcional de Rankin modificada (mRS ≥ 2: discapacidad moderada, moderadamente grave o grave); NIHSS: escala de gravedad del ictus del National Institute of Health; NS: no significativo. |
Tabla III. Número de pacientes supervivientes a los 12 meses y media de días de supervivencia en el primer año tras el ictus en función de las variables estudiadas. |
|||||||
Mujeres (n = 236) |
Hombres (n = 308) |
||||||
Sobreviven 12 meses |
Días de supervi-vencia media (EE) |
p a |
Sobreviven 12 meses |
Días de supervi-vencia media (EE) |
p a |
||
Edad |
< 65 años |
33 (94,3%) |
344 (13,9) |
0,004 |
87 (94,6%) |
357 (4,5) |
< 0,001 |
65-74 años |
42 (95,5%) |
353 (8,1) |
78 (92,9%) |
348 (7,5) |
|||
75-84 años |
82 (86,3%) |
335 (8,8) |
85 (89,5%) |
334 (9,6) |
|||
≥ 85 años |
46 (74,2%) |
288 (17,5) |
23 (62,2%) |
264 (24) |
|||
Nivel de estudios |
Sin estudios |
30 (81,1%) |
303 (21,1) |
0,06 |
15 (60%) |
246 (30,1) |
< 0,001 |
Primarios |
132 (84,1%) |
326 (8) |
135 (85,4%) |
330 (7,7) |
|||
Secundarios + superiores |
41 (97,6%) |
356 (8,4) |
123 (98,4%) |
362 (2,2) |
|||
Capacidad funcional previa (mRS) |
0-1 |
154 (92,2%) |
344 (5,9) |
< 0,001 |
242 (93,8%) |
352 (3,8) |
< 0,001 |
≥ 2 |
49 (71%) |
287 (16,1) |
31 (62,0%) |
256 (20,8) |
|||
NIHSS |
0-1 |
62 (96,9%) |
360 (4,3) |
< 0,001 |
109 (96,5%) |
355 (5,1) |
< 0,001 |
2-5 |
76 (89,4%) |
344 (7,3) |
94 (89,5%) |
347 (6,3) |
|||
6-15 |
49 (80,3%) |
311 (15,1) |
49 (83,1%) |
308 (16,4) |
|||
≥ 16 |
16 (61,5%) |
233 (32,8) |
21 (67,7%) |
286 (23,5) |
|||
Antecedentes de infarto cerebral o ICT |
Sí |
51 (89,5%) |
339 (11,2) |
NS |
61 (82,4%) |
310 (14,1) |
0,04 |
No |
152 (84,9%) |
324 (7,8) |
212 (90,6%) |
344 (4,8) |
|||
Síntomas-imagen |
> 90 min |
85 (87,6%) |
332 (9,4) |
NS |
100 (90,9%) |
338 (8,3) |
NS |
≤ 90 min |
118 (84,9%) |
325 (8,9) |
173 (87,4%) |
335 (6,4) |
|||
Recanalización |
Sí |
36 (90%) |
339 (13,8) |
NS |
44 (88%) |
331 (13,7) |
NS |
No |
167 (85,2%) |
325 (7,3) |
229 (88,8%) |
337 (5,4) |
|||
Ingreso en la unidad de ictus |
Sí |
115 (87,8%) |
332 (8,4) |
NS |
172 (88,2%) |
336 (6,5) |
NS |
No |
88 (83,8%) |
322 (10,2) |
101 (89,4%) |
337 (8) |
|||
EE: error estándar; ICT: isquemia cerebral transitoria; mRS: escala de capacidad funcional de Rankin modificada (mRS ≥ 2: discapacidad moderada, moderadamente grave o grave); NIHSS: escala de gravedad del ictus del National Institute of Health; NS: no significativo. a Significación del test log-rank. |
Figura 1. Evolución ajustada de la supervivencia de la cohorte de mujeres en los 12 meses de seguimiento.
Figura 2. Evolución ajustada de la supervivencia de la cohorte de hombres en los 12 meses de seguimiento.
Relationship between level of education and one-year survival after ischaemic stroke Introduction. The relationship between socioeconomic status and incidence or stroke mortality rates is well established. The evidence of an association between this variable and survival is less conclusive. Level of education is a widely-used measure of socioeconomic status in elderly people. Aim. To assess the relationship between one-year survival after stroke and level of education. Patients and methods. We analysed data on 544 consecutively recruited patients admitted for acute ischaemic stroke in one the public hospitals of Bizkaia (Spain). Data were obtained through interviews with patients or accompanying persons and from medical records. We studied variables concerning previous functional status, stroke severity, cardiovascular risk factors and stroke care provided. Patients were followed up for 12 months and the dates of any deaths were recorded. Univariate and multivariate analyses were carried out to assess the relationship between level of education and survival. Results. A total of 203 (86%) women and 273 (88.6%) men were alive at 12 months. In both sexes, individuals with a lower level of education had poorer previous functional status, more severe strokes and higher mortality rates. In the multivariate analysis, the association between level of education and survival remained significant in the adjusted model in men. Conclusions. In our setting, there are differences in the survival of patients with ischaemic stroke as a function of level of education. The impact of this factor was greater in men than women. Key words. Cerebrovascular disease. Educational level. Ischaemic stroke. Lethality. Risk factors. Survival. |