Older Stroke Patients Get Poorer Treatment, Says BMJ

Older people are less likely to receive drug treatment after a stroke compared to younger people, despite the fact that treatment is equally effective.

A study published on bmj.com today shows there is also some indication that women may be less likely to receive treatment than men, but patients' social and economic circumstances are not linked to differences in treatment, the findings show.

Stroke is the second most common cause of death after coronary heart disease in developed countries and 80% of cases occur in people over 64 years of age.

After a stroke, patients should receive a combination of drugs to help prevent another stroke. This is known as secondary drug prevention.

The drugs used are blood pressure and cholesterol lowering drugs, and anti-clotting drugs.

Previous studies have suggested that elderly people, socially disadvantaged people and women are less likely to receive medical interventions compared to younger, affluent people and to men.

As a result, researchers based in London decided to test this theory for stroke treatment.

They analysed data for 12,830 patients aged 50 years and above from 113 general practices in England.

All participants had experienced a stroke between 1995 and 2005 and had survived the first 30 days after their stroke.

Rates of secondary drug prevention were generally low - only 25.6% of men and 20.8% of women received treatment.

This did not vary by socio-economic circumstances. However, older patients were substantially less likely to receive cholesterol lowering treatment (26.4% of patients aged 50-59 received treatment compared with 15.6% of patients aged 80-89 and just 4.2% of those aged 90 or more).

This variation in treatment is important, say the authors, because secondary drug prevention halved the risk of dying during the first year after a stroke (on average, patients on treatment had a 5.7% risk of death within the first year compared to 11.1% for patients not on treatment).

Survival differed between social groups and gender - the most socially disadvantaged patients had lower one year survival than the most affluent, and women had a higher likelihood of one year survival than men – but this was not due to treatment differences.

The authors conclude that under-treatment of older people cannot be justified because older people are at least as likely to benefit from treatment as younger people, say the authors.

This issue must be addressed if the Government is to fulfil its commitment to reducing health care inequalities, they concluded.


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