Low socioeconomic status (SES) is associated with increased risk of death and disability after stroke, but interventional targets to minimize disparities remain unclear. We aim to assess the extent to which SES-based disparities in the association between low SES and death and dependency at 3 months after stroke could be eliminated by offsetting differences in comorbidity, stroke severity, and acute care.

This nationwide register-based cohort study included all 72 hospitals caring for patients with acute stroke in Sweden. All patients registered with an acute ischemic stroke in the Swedish Stroke Register in 2015–2016 who were independent in activities of daily living (ADL) during stroke were included. Data on survival and SES the year before stroke were retrieved by cross-linkage with other national registers. SES was defined by education and income and categorized into low, mid, and high. Causal mediation analysis was used to study the absolute risk of death and ADL dependency at 3 months depending on SES and to what extent hypothetical interventions on comorbidities, stroke severity, and acute care would equalize outcomes.

Of the 25,846 patients in the study, 6,798 (26.3%) were dead or ADL dependent 3 months after stroke. Adjusted for sex and age, low SES was associated with an increased absolute risk of 5.4% (95% CI 3.9%–6.9%; p < 0.001) compared with mid SES and 10.1% (95% CI 8.1%–12.2%; p < 0.001) compared with high SES. Intervening to shift the distribution of all mediators among patients with low SES to those of the more privileged groups would result in absolute reductions of these effects by 2.2% (95% CI 1.2%–3.2%; p < 0.001) and 4.0% (95% CI 2.6%–5.5%; p < 0.001), respectively, with the largest reduction accomplished by equalizing stroke severity.

Low SES patients have substantially increased risks of death and ADL dependency 3 months after stroke compared with more privileged patient groups. This study suggests that if we could intervene to equalize SES-related differences in the distributions of comorbidity, acute care, and stroke severity, up to 40 of every 1,000 patients with low SES could be prevented from dying or becoming ADL dependent.

低社会经济地位（SES）与中风后死亡和残疾风险增加相关，但最小化差异的干预目标仍不清楚。我们的目的是评估低 SES 与卒中后 3 个月死亡和依赖性之间基于 SES 的差异在多大程度上可以通过抵消共病、卒中严重程度和急性护理方面的差异来消除。

这项基于登记的全国性队列研究涵盖了瑞典所有 72 家治疗急性中风患者的医院。2015-2016 年在瑞典卒中登记册中登记的所有急性缺血性卒中患者均纳入其中，且卒中期间日常生活活动 (ADL) 独立。通过与其他国家登记册的交叉链接检索中风前一年的生存率和社会经济地位数据。SES根据教育程度和收入来定义，分为低、中、高。因果中介分析用于研究 3 个月时死亡和 ADL 依赖的绝对风险，具体取决于 SES，以及对合并症、中风严重程度和急性护理的假设干预在多大程度上可以均衡结果。

在该研究的 25,846 名患者中，6,798 名患者 (26.3%) 在中风后 3 个月死亡或依赖 ADL。调整性别和年龄后，与中 SES 相比，低 SES 绝对风险增加 5.4%（95% CI 3.9%–6.9%；p < 0.001），绝对风险增加 10.1%（95% CI 8.1%–12.2%； p < 0.001）。< 0.001) 与高 SES 相比。进行干预，将低 SES 患者中所有介质的分布转移到更有特权的群体中，将导致这些效应的绝对减少 2.2%（95% CI 1.2%–3.2%；p < 0.001）和 4.0%（95 % CI 分别为 2.6%–5.5%；p < 0.001），最大程度的降低是通过平衡中风严重程度来实现的。

与较高特权的患者群体相比，低 SES 患者中风后 3 个月的死亡和 ADL 依赖风险显着增加。这项研究表明，如果我们能够进行干预，以平衡与 SES 相关的共病、急性护理和中风严重程度分布方面的差异，那么每 1,000 名低 SES 患者中，多达 40 名患者可以避免死亡或成为 ADL 依赖者。