Advances in stroke: Health policy/outcomes research 2013.

S ince the last advances article on health policy and outcomes , 1 selected developments include new knowledge on long-term outcomes after stroke and their policy relevance, associations of neighborhood disadvantage with stroke mortality , growth and effect of regionalized systems of stroke care, and preliminary research relevant to policies on early stroke mortality as a hospital performance measure. The South London Stroke Register of incident strokes across a multiethnic, urban population reported that long-term survival gradually improved in consecutive cohorts of patients with stroke from 1995 to 2010, and higher survival was associated with stroke unit admission (hazard ratio, 0.75; P<0.0001). 2 Concurrently, stroke unit admission had increased dramati-Although evidence of benefit from stroke units has existed for several decades, there have been barriers to widespread adoption that may be addressed through local or national policies. Annual assessments for depressive symptoms in this registry cohort demonstrated that the presence of depressive symptoms after stroke is dynamic, often being of short duration but with a high risk of recurrence over time. 3 About one third of patients were depressed at 3 months after stroke, with resolution of symptoms among half of those by 1 year. However, depression was detected at least once in more than half of all patients with stroke in this cohort at some point in the follow-up of ≤15 years. The annual poststroke incidence of depression was estimated as ranging from a low of 7% to a high of 21%. This finding highlights the value of policies to foster periodic/repeated surveillance for depression after stroke, not only in the initial year but also long-term. Studies of neighborhood-level characteristics and associations with stroke occurrence and outcomes, including mortality , could eventually lead to policy interventions focusing on changing selected characteristics of communities, for example, increasing the availability of parks and healthy food venues for risk factor reduction or increasing local medical care facilities and providers. One study of patients with stroke in the province of Ontario, Canada, found that patients with stroke from the highest quintile of median neighborhood income had lower 1-year mortality than those from the lowest quintile (adjusted hazard ratio, 1.18; 95% confidence interval, 1.03–1.29), even after accounting for age, sex, comorbidities, stroke type and severity, type of hospital, provider specialty, and whether cared for on an acute stroke unit. 4 Analysis of Cardiovascular Health Study data, which had the advantage of including both individual …