Between rich and poor, inequality is also part of health. Unveiled this Wednesday, the study that the Drees (Direction of research, studies, evaluation and statistics) devoted to the occurrence of cerebrovascular accidents (CVA) – one of the main causes of death in France, responsible for 123,000 hospitalizations in 2019 – provides a new example.
Based on the permanent demographic sample matched with health data (EDP-Santé), its experts have for the first time measured the impact of socio-economic disparities on the occurrence of strokes, their severity and their management by the neurovascular pathway (UNV). Their conclusion is striking: between 2014 and 2017, the frequency of occurrence of a stroke among people belonging to the poorest quarter of the population is 40% higher than among those belonging to the wealthiest quarter. Between the ages of 45 and 64, the occurrence rate is almost twice as high if one is poor. The explanation is largely due to the way of life of each other. Scientific studies have in the past highlighted the link between stroke and certain risk factors more frequent in the underprivileged sections of the population, such as diabetes, obesity, high blood pressure, tobacco and alcohol consumption. .
10% less chance of going to a specialized structure
But this first inequality is coupled with another, even more worrying: more limited access to neurovascular units, services most likely to improve the chances of recovery and survival of patients in the event of ischemic stroke (most often linked occlusion of a cerebral artery by a blood clot).
In general, the management of this type of stroke has improved. In 2017, 14.2% of patients with ischemic stroke benefited from thrombolysis (a drug treatment that dissolves the blood clot blocking the cerebral artery), compared to only 1% in 2010. Between 2014 and 2017, half of patients with an ischemic stroke (52.9%) were cared for in UNV, the other half most often in conventional hospitalization services. But the DREES emphasizes that“A low standard of living is associated with a lower chance of being treated in a UNV at comparable age, sex and number of beds in the department”. More precisely, the most modest people have 10% less chance of being accommodated in these specialized structures. Should we conclude that the hospital would sort according to the social origin of the patients? Obviously not.
Paralysis and increased language impairment
Even if the DREES is still at the stage of hypotheses, the explanation would rather lie in the lesser reactivity of the patients and their entourage, care in a UNV being only possible within 4h30 after the onset of symptoms. However, specifies the DREES, international studies suggest that “among the most disadvantaged, the signs of stroke are more rarely recognized”. This is followed by possible delays in the use of emergency medical services (calling Samu or 112 which should be the rule in the event of any suspicion of stroke). Furthermore, “these signs could also be less well described, which can influence the orientation of patients with, consequently, a potential lengthening of the delays between the call for the Samu and the realization of the imaging (MRI or scanner) allowing the diagnosis and hence treatment.
If there is assumed discrimination, it is more a function of age. In fact, in areas where there are quotas, the beds in the UNV are given priority to the youngest patients. Still, less well taken care of, strokes have more serious consequences whether you are at the top or bottom of the social scale. “Belonging to the 25% of the most modest people increases the risk of 22% of paralysis that persists beyond twenty-four hours, specifies the Drees. The same is true for language disorders where the risk is increased by 11% in the most modest compared to people belonging to the wealthiest 25%. Another form of double jeopardy.