1. Socio-economic gradients in the occurrence of stroke and 30 days in- hospital mortality after a stroke in Canada 2014 Canadian Population Health Association Conference Toronto, Canada Z. Chaudhary, K. Nguyen, L. Yin, C. Tosevski, Y. Gurevich Canadian Institute for Health Information

2. Overview Introduction –Why Stroke? –Indicators (Stroke Event and 30-Day Stroke In-hospital Mortality) SES lens Results Concluding remarks Resources 2

3. Why Stroke? 3 Stroke Among top 10 causes of in-hospital mortality Common cause of hospitalization Cost

4. Stroke Indicators Stroke Event Rate Age-standardized rate of new stroke events admitted to an acute care hospital, per 100,000 population age 20 and older 30-Day Stroke In-Hospital Mortality The risk-adjusted rate of all-cause in-hospital deaths occurring within 30 days of first admission to an acute care hospital with a diagnosis of stroke 4

5. General Methodology Data Source - Discharge Abstract Database (DAD) Acute care hospitalization data from all provinces/territories except Quebec Rates for Quebec are not available due to differences in data collection Level of Reporting - based on patient postal code of residence Canada Provinces/territories Regions 5

6. SES Lens  Social stratification and income distribution have an impact on population health and safety  Measuring and reporting health disparities are important because some of them may be reduced or prevented  Understanding Stroke in the socio-economic context could help to focus on areas where interventions are more needed 6

7. SES Lens (cont’d) Neighbourhood Income Quintile - used as a proxy for SES (Quintile 1 – least affluent, Quintile 5 - most affluent) Disparity Rate Ratio Ratio of the rate of a health indicator for the least affluent neighbourhood income quintile to the rate for the most affluent neighbourhood income quintile Potential Rate Reduction Potential reduction in a health indicator rate that would occur in the hypothetical scenario that each socio-economic group in the jurisdiction experienced the rate of the most affluent socio- economic group 7

8. Hospitalized Stroke Events Rate - National Trend 8 *Age-Standardized Rates exclude Quebec ↓ 9% ↓ 11%

9. Hospitalized Stroke Event Rate - Provincial Variation FY2007-2008 & FY2012-2013 9 130 118

10. Stroke Event Rate - by SES FY 2007-2008 & FY 2012-2013 10

11. Stroke Event Rate - by SES and Gender FY 2012-2013 11

12. Hospitalized Stroke Rates - by SES & Province FY 2012-2013 12 PRR-11% ↓

13. 30-Day Stroke In-hospital Mortality National Trend 13

14. 30-day In-hospital Stroke Mortality Provincial Variation, 2009 & 2011 14

15. 30-day In-hospital Stroke Mortality - by SES 2009 & 2011 15

16. Concluding Remarks Hospitalizations for stroke present a consistent association with socio-economic status. However once the patients are admitted to hospital difference in stroke mortality rates by socio-economic status are much less Examining trends and variations could help jurisdictions identify areas for improvement Could be used to target efforts needed to close sex and socio-economic gaps 16

17. Resources OurHealthSystem.ca website –Indicator results at national, provincial/territorial and health region level www.OurHealthSystem.ca Health Indicators e-publication –Indicator results at national, provincial /territorial and health region level www.cihi.ca/hirpt Indicator Library –http://indicatorlibrary.cihi.cahttp://indicatorlibrary.cihi.ca 17

18. Questions? Zeerak Chaudhary Project Lead, Health Indicators & Client Support, Canadian Institute for Health Information (CIHI) Email: zchaudhary@cihi.cazchaudhary@cihi.ca

19. 19 Thank You!