Table_1_A Prospective Comparative Study of Health Inequalities and the Epidemiology of Stroke in French Guiana and Dijon, France.xlsx

BackgroundIn French Guiana poverty is widespread and specialized care is lacking. We aimed to compare strokes between precarious and non-precarious patients within French Guiana and to compare the epidemiology of ischemic strokes and their outcomes between French Guiana and mainland France.MethodsA multicenter prospective cohort examined the influence of social inequalities on stroke characteristics. Consecutive patients aged > 18 years admitted for an acute ischemic stroke, confirmed by neuroimaging were eligible. Exclusion criteria were a history of symptomatic stroke, presence of other short-term life-threatening diseases and inability to contact patients by telephone during follow-up. Social deprivation was measured using the EPICES score, which is based on a multidimensional questionnaire.ResultsOverall, 652 patients with ischemic stroke were included. The patients in French Guiana were 7 years younger, were more frequently male, of sub-Saharan ancestry, they had a low level of education, and were more often precarious (67.7%) than the patients included in Dijon (39.2%). The origin of the ischemic stroke was predominantly lacunar for patients included in French Guiana and cardioembolic for patients included in Dijon, with greater severity for patients included in Dijon. The proportion of patients with known pre-stroke hypertension, diabetes, or a history of Transient Ischemic Accident was greater in French Guiana than in Dijon. In contrast, hypercholesterolemia, atrial fibrillation, and history of Myocardial Infarction were more frequently found in patients included in Dijon than in patients included in French Guiana. Fibrinolysis was less frequent in French Guiana than in Dijon, 24% of patients arriving early enough receiving thrombolysis in French Guiana vs. 45% in Dijon, P < 0.0001. However, after adjustment for patient characteristics, the effect of the center on the use of fibrinolysis disappeared. When comparing precarious and non-precarious patients within French Guiana, the main difference was the younger age and the lower mortality of precarious patients—notably immigrants.ConclusionPrecariousness was widespread in French Guiana. Within French Guiana, despite a younger age among foreigners than French patients, the risk factors, mechanisms, and outcomes were homogenous across socioeconomic strata. The observed differences between the two contrasted French territories suggested that, beyond health inequalities, the epidemiology of cardiovascular risk factors may differ between French Guiana and mainland France.

背景：在法属圭亚那，贫困现象普遍存在，专业医疗服务匮乏。本研究旨在比较法属圭亚那地区不稳定经济状况与稳定经济状况的患者之间的卒中情况，并对比法属圭亚那与法国本土缺血性卒中的流行病学特征及其预后。方法：一项多中心前瞻性队列研究探讨了社会不平等对卒中特征的影响。连续入组的年龄大于18岁的急性缺血性卒中患者，经神经影像学确诊者纳入研究。排除标准包括有症状性卒中病史、存在其他短期危及生命的疾病以及随访期间无法通过电话联系患者。社会剥夺程度通过EPICES评分进行测量，该评分基于多维问卷调查。结果：总共纳入652例缺血性卒中患者。法属圭亚那的患者平均年龄较法国本土患者年轻7岁，男性比例更高，属于撒哈拉以南非洲血统，教育水平较低，且不稳定经济状况的患者比例（67.7%）高于法国本土（39.2%）。法属圭亚那入组的缺血性卒中患者以腔隙性起源为主，而法国本土患者以心源性栓塞为主，且法国本土患者的病情更为严重。法属圭亚那患者中已知的前卒中高血压、糖尿病或短暂性脑缺血发作病史的比例高于法国本土。相反，高胆固醇血症、心房颤动和心肌梗死病史在法国本土患者中比法属圭亚那患者更为常见。法属圭亚那的纤溶治疗发生率低于法国本土，法属圭亚那有24%的患者在到达时足够早，接受了溶栓治疗，而法国本土为45%，P < 0.0001。然而，经过对患者特征的调整后，中心对纤溶治疗使用的影响消失。在比较法属圭亚那不稳定经济状况与稳定经济状况的患者时，主要差异在于不稳定经济状况患者的年龄更轻且死亡率更低，尤其是移民患者。结论：法属圭亚那地区不稳定经济状况普遍存在。在法属圭亚那，尽管外国患者的年龄低于法国本土患者，但在社会经济各个阶层中，风险因素、发病机制和预后均具有同质性。观察到的两个对比鲜明的法国领土之间的差异表明，除健康不平等之外，心血管风险因素的流行病学特征可能在法属圭亚那与法国本土之间存在差异。