Fast near-infrared photodetectors from p-type SnSe nanoribbons.

Low-dimensional tin selenide nanoribbons (SnSe NRs) show a wide range of applications in optoelectronics fields such as optical switches, photodetectors, and photovoltaic devices due to the suitable band gap, strong light-matter interaction, and high carrier mobility. However, it is still challenging to grow high-quality SnSe NRs for high-performance photodetectors so far. In this work, we successfully synthesized high-quality p-type SnSe NRs by chemical vapor deposition and then fabricated near-infrared photodetectors. The SnSe NR photodetectors show a high responsivity of 376.71 A W-1, external quantum efficiency of 5.65 × 104%, and detectivity of 8.66 × 1011Jones. In addition, the devices show a fast response time with rise and fall time of up to 43µs and 57µs, respectively. Furthermore, the spatially resolved scanning photocurrent mapping shows very strong photocurrent at the metal-semiconductor contact regions, as well as fast generation-recombination photocurrent signals. This work demonstrated that p-type SnSe NRs are promising material candidates for broad-spectrum and fast-response optoelectronic devices.

Association of air pollution with dementia: a systematic review with meta-analysis including new cohort data from China.

It remains unclear whether a total exposure to air pollution (AP) is associated with an increased risk of dementia. Little is known on the association in low- and middle-income countries. Two cohort studies in China (in Anhui cohort 1402 older adults aged ≥ 60 followed up for 10 years; in Zhejiang cohort 6115 older adults followed up for 5 years) were conducted to examine particulate matter - PM2.5 associated with all dementia and air quality index (AQI) with Alzheimer's disease, respectively. A systematic literature review and meta-analysis was performed following worldwide literature searched until May 20, 2020 to identify 15 population-based cohort studies examining the association of AP with dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI. The cohort studies in China showed a significantly increased relative risk (RR) of dementia in relation to AP exposure; in Anhui cohort the adjusted RR was 2.14 (95% CI 1.00-4.56) in people with PM2.5 exposure at ≥ 64.5 µg/m3 versus <63.5 µg/m3 and in Zhejiang cohort the adjusted RR was 2.28 (1.07-4.87) in AQI>90 versus ≤ 80. The systematic review revealed that all 15 studies were undertaken in high income countries/regions, with inconsistent findings. While they had reasonably good overall quality of studies, seven studies did not adjust smoking in analysis and 13 did not account for depression. Pooling all eligible data demonstrated that dementia risk increased with the total AP exposure (1.13, 1.08-1.19). Data analysis of air pollutants showed that the RR significantly increased with PM2.5 (1.06, 1.03-1.10 in 2nd tertile exposure; 1.13, 1.07-1.19 in 3rd tertile versus 1st tertile), PM10 (1.05, 0.86-1.29; 1.62, 0.60-4.36), carbon monoxide (1.69, 0.72-3.93; 1.52, 1.35-1.71), nitrogen dioxide (1.06, 1.03-1.09; 1.18, 1.10-1.28) and nitrogen oxides (1.09, 1.04-1.15; 1.26, 1.13-1.41), but not ozone. Controlling air pollution and targeting on specific pollutants would reduce dementia globally.

The role of depressive symptoms and social support in the association of internet addiction with non-suicidal self-injury among adolescents: a cohort study in China.

BACKGROUND: Both internet addiction (IA) and non-suicidal self-injury (NSSI) are major public health concerns among adolescents, however, the association between IA and NSSI was not well understood. We aimed to investigate the association between IA and NSSI within a cohort study, and explore the mediated effect of depressive symptoms and the moderating effect of social support in the association. METHODS: A total of 1530 adolescents aged 11-14 years who completed both the baseline (T1) and 14-month follow-up (T2) survey of the Chinese Adolescent Health Growth Cohort were included for the current analysis. IA, NSSI, depressive symptoms and social support were measured at T1; depressive symptoms and NSSI were measured again at T2. Structural equation models were employed to estimate the mediated effect of depressive symptoms and the moderating effect of social support in the association between IA and NSSI at T2. RESULTS: IA was independently associated with an increased risk of NSSI at T2, with the total effect of 0.113 (95%CI 0.055-0.174). Depressive symptoms mediated the association between IA and NSSI at T2, and social support moderated the indirect but not the direct effect of IA on NSSI at T2. Sex differences were found on the mediated effect of depressive symptoms and the moderated mediation effect of social support. CONCLUSIONS: Interventions that target adolescents' NSSI who also struggle with IA may need to focus on reducing depressive symptoms and elevating social support.

Complex association of self-rated health, depression, functional ability with loneliness in rural community-dwelling older people.

BACKGROUND: This study aimed to explore whether and how self-rated health, depression and functional ability interactively associated with loneliness using a sample group of older adults residing in China rural communities. METHODS: Data on socio-demographic information, self-rated health, depressive symptoms, functional ability and loneliness (quantified via a single question) were collected from 1009 participants. Cross-tabulations with chi-square test, bivariate correlations, and Classification and Regression Tree (CART) models were employed for analysis. RESULTS: We found that 45.1% of the participants were classified as lonely. Our results gain insight into the hierarchical order of predictors for the presence of loneliness, suggesting that there was a significant interaction between functional ability and depressive symptoms while self-rated health was not a significant factor. The probability of loneliness increased with the combination of limited functional ability and depression, and varied with different interaction of functional ability, depressive symptoms, and marital status, respectively. Notably, while there were some differences, similar associations were observed among older male and female respondents. CONCLUSION: To delay or reduce loneliness, early detection which focuses on older people who report limitations in functional ability, depression, and being female, offers opportunities to start early interventions. Our findings might be helpful not only in designing and implementing loneliness prevention programs but also in improving healthcare for older rural community-dwelling people.

The Efficacy of Physical Fitness Training on Dance Injury: A Systematic Review.

Greater levels of physical fitness have been linked to improved dance performance and decreased injury incidence. The aim was to review the efficacy of physical fitness training on dance injury. The electronic databases CINAHL, Cochrane Library, PubMed, Web of Science, MEDLINE, China National Knowledge Infrastructure were used to search peer-reviewed published articles in English or Chinese. Studies were scored using Strength of the Evidence for a Conclusion and a risk bias checklist. 10 studies met the inclusion criteria from an initial 2450 publications. These studies offered physical fitness training for professional (n=3) and pre-professional dancers (n=7), participant sample size ranged between 5 to 62, ages from 11 to 27 years, and most participants were females. Assessment scores were classified as Fair (n=1), Limited (n=7), and Expert Opinion Only (n=2) and risk of bias scores ranged from 22.7-68.2%. After physical fitness training, 80% of studies reported significant benefits in injury rate, the time between injuries, pain intensity, pain severity, missed dance activities and injury count. This review suggests that physical fitness training could have a beneficial effect on injury incidence in dance. The evidence is limited by the current study methodologies.

Small-diameter p-type SnS nanowire photodetectors and phototransistors with low-noise and high-performance.

P-type nanostructured photodetectors and phototransistors have been widely used in the field of photodetection due to their excellent electrical and optoelectronic characteristics. However, the large dark current of p-type photodetectors will limit the detectivity. Herein, we synthesized small-diameter single-crystalline p-type SnS nanowires (NWs) and then fabricated single SnS NW photodetectors and phototransistors. The device exhibits low noise and low dark current, and its noise current power is as low as 2.4 × 10-28A2. Under 830 nm illumination and low power density of 0.12 mW cm-2, the photoconductive gain, responsivity and detectivity of the photodetector are as high as 3.9 × 102, 2.6 × 102A W-1and 1.8 × 1013Jones, respectively, at zero gate voltage. The rise and fall time of response are about 9.6 and 14 ms. The experimental results show that the small-diameter p-type SnS NWs have broad application prospects in high-performance and low-power photodetectors with high sensitivity, fast response speed and wide spectrum detection in the future.

Impact of fish consumption on all-cause mortality in older people with and without dementia: a community-based cohort study.

BACKGROUND: Increased fish consumption reduces the risk of dementia. However, it is unknown whether fish consumption reduced all-cause mortality in people with dementia. The purpose of the study is to investigate the association of fish consumption with all-cause mortality in older people with dementia versus those without dementia. METHODS: Using a standard method of the Geriatric Mental State, we interviewed 4165 participants aged ≥ 60 years who were randomly recruited from five provinces in China during 2007-2009 to collect the baseline data of socio-demography, disease risk factors, histories of disease, and details of dietary intakes, and diagnosed dementia (n = 406). They were followed up for vital status until 2012. RESULTS: The cohort follow-up documented 329 deaths; 61 were in participants with dementia (55.3 per 1000 person-years) and 224 were those without dementia (22.3). In all participants, the risk of all-cause mortality was reduced with fish intake at " ≥ twice a week" (multivariate-adjusted hazard ratio 0.58, 95% CI 0.34-0.96) and at "once a week or less" (0.79, 0.53-1.18) compared to "never eat" over the past two years. In participants without baseline dementia, the corresponding HRs for all-cause mortality were 0.57 (0.33-0.98) and 0.85 (0.55-1.31), while in participants with dementia were 1.36 (0.28-6.60) and 1.05 (0.30-3.66), respectively. CONCLUSION: This study reveals that consumption of fish in older age reduced all-cause mortality in older people without dementia, but not in people with dementia. Fish intake should be increased in older people in general, prior to the development of dementia in the hope of preventing dementia and prolonging life.

Impact of air pollution exposure on the risk of Alzheimer's disease in China: A community-based cohort study.

Alzheimer's disease (AD) is the most common type of dementia. Impact of air pollution (AP) on the risk of AD is unclear. It is unknown which air pollutants are independently associated with AD and whether fish consumption mitigated the association. We carried out a community-based cohort of 6115 participants aged ≥60 years in China to examine the association of PM2.5, PM10, CO, NO2, SO2 and O3 exposure with AD, and differences in the association between people with low and high consumption of fish. The participants were randomly recruited from six counties in Zhejiang province for health survey to document socio-demographic and disease risk factors in 2014, and were followed up to diagnose AD in 2019. A total of 986 cohort members were diagnosed with AD. Based on the daily mean air pollutants monitored in 2013-2015 in the counties, participants were divided into low, middle and high AP exposure groups for subsequent analysis. The multiple adjusted odds ratio (OR) of AD in participants living with the middle and high levels of PM2.5 exposure versus the low exposure were 1.50 (95% CI 0.90-2.50) and 3.92 (2.09-7.37). The increased ORs were also with PM10 (1.74, 0.65-4.64; 3.00, 1.22-7.41) and CO (2.86, 1.32-6.20; 1.19, 0.45-3.18), but not with NO2 (0.63, 0.17-2.27; 0.95, 0.28-3.19), SO2 (0.44, 0.19-1.001; 1.21, 0.56-2.62), and O3 (0.38, 0.20-0.74; 0.50, 0.21-1.21). There were no significant interaction effects of AP with fish consumption on AD. However, participants with low consumption of fish appeared to have higher ORs in PM2.5 exposure (1.80, 1.39-2.33; 5.18, 3.93-6.82) than those high consumption (1.38, 0.78-2.47; 2.89, 1.50-5.59). Our findings of PM2.5, PM10 and CO exposure significantly increased the risk of AD and the potential mitigating effect of fish consumption on the association provide evidence for developing effective strategies for AD reduction and air pollution control.

Impacts of depression subcase and case on all-cause mortality in older people: The findings from the multi-centre community-based cohort study in China.

OBJECTIVES: It is unclear whether and to what extent depression subcases and cases in older age were associated with all-cause mortality. Little is known about gender differences in the associations. We assess these in older Chinese. METHODS: We examined a random sample of 6124 participants aged ≥60 years across five provinces in China. They were interviewed using a standard method of the GMS-AGECAT to diagnose depression subcase and case and record sociodemographic and disease risk factors at baseline, and to follow up their vital status. We employed Cox regression models to determine all-cause mortality in relation to depression subcases and cases, with adjustment for important variables, including social support and co-morbidities. RESULTS: Over the 10-year follow-up, 928 deaths occurred. Compared to those without depression at baseline, participants with depression subcase (n = 196) and case (n = 264) had increased risk of mortality; adjusted hazard ratios (HRs) were 1.46 (95% CI 1.07-2.00) and 1.45 (1.10-1.91). The adjusted HRs in men were 1.15 (0.72-1.81) and 1.85 (1.22-2.81), and in women 1.87 (1.22-2.87) and 1.22 (0.83-1.77) respectively. In participants aged ≥65 years, the adjusted HRs were 1.12 (0.68-1.84) and 1.99 (1.28-3.10) in men, and 2.06 (1.32-2.24) and 1.41 (0.94-2.10) in women. Increased HR in depression subcases was higher in women than man (ratio of HRs was 1.84, p = 0.034). CONCLUSIONS: Older people with depression subcase could have increased all-cause mortality to a similar extent to those with depression case. More attention should be paid to subcases of depression in women to tackle gender inequalities and improve survival.

Influence of periodontal disease on risk of dementia: a systematic literature review and a meta-analysis.

Periodontal disease (PD) is common and increases cardiovascular diseases. However, it is unclear whether PD is associated with increased risk of dementia. We carried out a systematic review and meta-analysis to investigate the influence of PD on dementia. We projected the number of dementia cases to be saved by reducing PD prevalence in the world. We searched cohort and case-control studies reporting the association of PD with all dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI until 7th November 2018. Five cohorts and seven case-control studies were identified for review. We pooled eligible data to calculate relative risk (RR) of dementia in relation to PD and computed the number of dementia cases saved through reducing PD prevalence. Of 12 studies, six were undertaken in Asia, four in Europe and two in America. Eleven studies showed a positive association between PD and the risk of dementia, of which 10 were significant, and one reported a non-significant inverse association. Overall their quality was good. Pooled RR of dementia in relation to PD from all high quality studies was 1.38 (95%CI 1.01-1.90); in the five cohorts was 1.18 (1.06-1.31) and in the two case-control studies 2.25 (1.48-3.42). A 50% reduction in the current prevalence of 20% of PD in the population could save 850,000 (630,000-1,420,000) patients with dementia in the world. PD could increase the risk of incident dementia. Preventing and treating PD could contribute to controlling the global epidemic of dementia.

Associations of adverse childhood experiences and social support with self-injurious behaviour and suicidality in adolescents.

BACKGROUND: There is little investigation on the interaction effects of adverse childhood experiences (ACEs) and social support on non-suicidal self-injury (NSSI), suicidal ideation and suicide attempt in community adolescent populations, or gender differences in these effects.AimsTo examine the individual and interaction effects of ACEs and social support on NSSI, suicidal ideation and suicide attempt in adolescents, and explore gender differences. METHOD: A school-based health survey was conducted in three provinces in China between 2013-2014. A total of 14 820 students aged 10-20 years completed standard questionnaires, to record details of ACEs, social support, NSSI, suicidal ideation and suicide attempt. RESULTS: Of included participants, 89.4% reported one or more category of ACEs. The 12-month prevalence of NSSI, suicidal ideation and suicide attempt was 26.1%, 17.5% and 4.4%, respectively; all were significantly associated with increased ACEs and lower social support. The multiple adjusted odds ratio of NSSI in low versus high social support was 2.27 (95% CI 1.85-2.67) for girls and 1.81 (95% CI 1.53-2.14) for boys, and their ratio (Ratio of two odds ratios, ROR) was 1.25 (P = 0.037). Girls with high ACEs scores (5-6) and moderate or low social support also had a higher risk of suicide attempt than boys (RORs: 2.34, 1.84 and 2.02, respectively; all P < 0.05). CONCLUSIONS: ACEs and low social support are associated with increased risk of NSSI and suicidality in Chinese adolescents. Strategies to improve social support, particularly among female adolescents with a high number of ACEs, should be an integral component of targeted mental health interventions.Declaration of interestNone.

Association of air pollution with the risk of initial outpatient visits for tuberculosis in Wuhan, China.

OBJECTIVES: Previous studies suggested the association of air pollution with initial Mycobacterium tuberculosis infection and the disease development. However, few studies have been conducted on air pollution and initial tuberculosis (TB) consults using short-interval data. We investigated the weekly association between air pollution and initial TB outpatient visits. METHODS: We used a Poisson regression model combined with a distributed lag non-linear model to conduct a time-series study with weekly air pollution data and TB cases during 2014-2017 in Wuhan, China. RESULTS: A 10 µg/m3 increase in NO2 (nitrogen dioxide) was associated with 11.74% (95% CI: 0.70 to 23.98, lag 0-1 weeks), 21.45% (95% CI: 1.44 to 45.41, lag 0-2 weeks) and 12.8% (95% CI: 0.97 to 26.02, lag 0-1 weeks) increase in initial TB consults among all patients with TB, old patients (≥60 years old) and male ones, respectively. A 10 µg/m3 increase in SO2 (sulfur dioxide) was associated with -22.23% (95% CI: -39.23 to -0.49, lag 0-16 weeks), -28.65% (95% CI: -44.3 to -8.58, lag 0-16 weeks), -23.85 (95% CI: -41.79 to -0.37, lag 0-8 weeks) and -23.82% (95% CI: -41.31 to -1.11, lag 0-16 weeks) increase in initial TB consults among the total, young (aged 15-59 years old), old and male patients, respectively. In old patients, a 0.1 mg/m3 increase in CO (carbon monoxide) and a 10 µg/m3 increase in PM2.5 (particulate matter) were separately associated with 42.32% (95% CI: 1.16 to 100.22, lag 0-16 weeks) and 17.38% (95% CI: 0.28 to 37.38, lag 0-16 weeks) increases in TB consults. CONCLUSION: Our study first highlighted the importance of weekly association between air pollution and the risk of initial TB consults, which is helpful for the arrangements of TB screening and medical assistance.

Effects of berberine on blood glucose in patients with type 2 diabetes mellitus: a systematic literature review and a meta-analysis.

We conducted a systematic review and meta-analysis to evaluate the effect of Berberine on glucose in patients with type 2 diabetes mellitus and identify potential factors may modifying the hypoglycemic effect. We searched PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Database to identify randomized controlled trials that investigated the effect of Berberine. We calculated weighted mean differences (WMD) and 95% confidence interval (CI) for fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and glycated haemoglobin (HbA1c) levels. Twenty-eight studies were identified for analysis, with a total of 2,313 type 2 diabetes mellitus (T2DM) patients. The pool data showed that Berberine treatment was associated with a better reduction on FPG (WMD = -0.54 mmol/L, 95% CI: -0.77 to -0.30), PPG (WMD = -0.94 mmol/L, 95% CI: -1.27 to -0.61), and HbA1c (WMD = -0.54 mmol/L, 95% CI: -0.93 to -0.15) than control groups. Subgroup-analyses indicated that effects of Berberine on blood glucose became unremarkable as the treatment lasted more than 90 days, the daily dosage more than 2 g/d and patients aged more than 60 years. The efficiency of Berberine combined with hypoglycaemics is better than either Berberine or hypoglycaemic alone. The dosage and treatment duration of Berberine and patients' age may modify the effect.

Invited Commentary: Secondhand Smoke-an Underrecognized Risk Factor for Cognitive Decline.

Pan et al. (Am J Epidemiol. 2018;187(5):911-918) reported findings that exposure to secondhand smoke (SHS) was associated with cognitive decline over the course of 2 years among middle-aged and older Chinese women who never smoked, and they also reported a dose-response relationship. SHS exposure affects vulnerable people disproportionately because they have less control or choice over their living and working environment. Smoking is an established risk factor for dementia, but recent evidence reports on dementia-risk increase have not included SHS. Many epidemiologic studies collect data on smoking but not SHS exposure. SHS may be one of the most prevalent and modifiable risk factors for cognitive decline and therefore represents a major potential target for reduction of dementia risk. Given the high prevalence of smoking in China and other parts of the world, there is an urgent need to raise awareness of SHS reduction as part of global and national strategies to reduce cognitive decline and dementia and to introduce legislation that protects nonsmokers and vulnerable children and adults from SHS.

Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis.

OBJECTIVE: To assess the association of fish consumption with risk of dementia and its dose-response relationship, and investigate variations in the association among low-, middle- and high-income countries. DESIGN: A new community-based cross-sectional study and a systematic literature review.SettingsUrban and rural communities in China; population-based studies systematically searched from worldwide literature. SUBJECTS: Chinese adults aged ≥60 years in six provinces (n 6981) took part in a household health survey of dementia prevalence and risk factors. In addition, 33 964 participants from eleven published and eligible studies were included in the systematic review and meta-analysis. RESULTS: In the new study in China, 326 participants were diagnosed with dementia (4·7 %); those who consumed any amount of fish in the past two years v. those who consumed no fish had reduced risk of dementia (adjusted OR=0·73, 95 % CI 0·64, 0·99), but the dose-response relationship was not statistically significant. The meta-analysis of available data from the literature and the new study showed relative risk (RR) of dementia of 0·80 (95 % CI 0·74, 0·87) for people with fish consumption; the impact was similar among countries with different levels of income. Pooled dose-response data revealed RR (95 % CI) of 0·84 (0·72, 0·98), 0·78 (0·68, 0·90) and 0·77 (0·61, 0·98) in people with low, middle and high consumption of fish, respectively. Corresponding figures for Alzheimer's disease were 0·88 (0·74, 1·04), 0·79 (0·65, 0·96) and 0·67 (0·58, 0·78), respectively. CONCLUSIONS: Greater consumption of fish is associated with a lower risk of dementia. Increasing fish consumption may help prevent dementia worldwide regardless of income level.

Socioeconomic Status and the Quality of Acute Stroke Care: The China National Stroke Registry.

BACKGROUND AND PURPOSE: The association of socioeconomic status (SES) with quality of stroke care is not well understood, and few studies have examined the association with different indicators of SES simultaneously. We assessed the impacts of low levels of education, occupation, and income on the quality of stroke care. METHODS: We examined data from the China National Stroke Registry recording consecutive stroke patients between September 2007 and August 2008. Baseline low SES was measured using educational level <6 years, occupation as manual workers or no job, and average family income per capita at ≤¥1000 per month. Compliance with 11 performances was summarized in a composite score defined as the proportion of all needed care given. Poor quality of care was defined as having a composite score of 0.71 or less. RESULTS: Among 12 270 patients with ischemic stroke, 38.6% had <6 educational years, 37.6% had manual workers/no job, and 34.7% had income ≤¥1000 per month. There was an increased chance of receiving poor quality of care in patients with low education (adjusted odds ratio 1.15, 95% confidence interval 1.03-1.28), low occupation (adjusted odds ratio 1.16, 95% confidence interval 1.01-1.32), and low income (adjusted odds ratio 1.18, 95% confidence interval 1.06-1.30), respectively. People with low SES had poor performances on some aspects of care quality. Combined effects existed among these SES indicators; those with low SES from all 3 indicators had the poorest quality of care. CONCLUSIONS: There was a social gradient in the quality of stroke care. Continuous efforts of socioeconomic improvement will increase the quality of acute stroke care.

Exposure to air pollution and cognitive functioning across the life course--A systematic literature review.

OBJECTIVES: Air pollution is associated with increased risk of respiratory, cardiovascular and cerebrovascular disease, but its association with cognitive functioning and impairment is unclear. The aim of this systematic review was to examine whether a relationship exists between these variables across the life course. METHODS: We searched Web of Knowledge, Pubmed, SciVerse Scopus, CINAHL, PsychInfo and Science Direct up to October 2015 to identify studies that investigated the association between air pollution and performance on neurocognitive tests. RESULTS: Variations in exposure assessment and outcome measures make meta-analysis impossible. Thirty one studies published between 2006 and 2015, from the Americas (n=15), Asia (n=5) and Europe (n=11), met the criteria for inclusion. Many showed weak but quantified relationships between various air pollutants and cognitive function. Pollution exposure in utero has been associated with increased risk of neuro-developmental delay. Exposure in childhood has been inversely associated with neuro-developmental outcomes in younger children and with academic achievement and neurocognitive performance in older children. In older adults, air pollution has been associated with accelerated cognitive decline. CONCLUSIONS: The evidence to date is coherent in that exposure to a range of largely traffic-related pollutants has been associated with quantifiable impairment of brain development in the young and cognitive decline in the elderly. There is insufficient evidence at present to comment on consistency, in view of the different indices of pollution and end-points measured, the limited number of studies, and the probability at this stage of publication bias. However, plausible toxicological mechanisms have been demonstrated and the evidence as a whole suggests that vehicular pollution, at least, contributes to cognitive impairment, adding to pressure on governments and individuals to continue to reduce air pollution.

Impact of socioeconomic deprivation on mortality in people with haemorrhagic stroke: a population-based cohort study.

PURPOSE: Socioeconomic deprivation (SED) has an effect on many health outcomes, including ischaemic stroke; however, its impact on mortality after haemorrhagic stroke remains unclear, particularly in the long run. We examined this association in a multiethnic population in the UK. DESIGN: We examined data from 782 patients with first-ever haemorrhagic stroke, collected by the South London Stroke Register from 1995 to 2011. SED was defined as the quartile with the highest Carstairs scores, and was analysed in relation to mortality after stroke in a multivariate-adjusted Cox regression model. RESULTS: In a follow-up of 17 years, 498 patients died. Compared with the first quartile of Carstairs score (the least deprived), the multivariate-adjusted HRs for 17-year mortality in patients in the second, third and fourth quartiles were 0.94 (95% CI 0.72 to 1.23), 1.17 (95% CI 0.90 to 1.52) and 1.36 (95% CI 1.04 to 1.78), overall p=0.04. The SED gradient association remained in patients with intracerebral haemorrhagic stroke, while in patients with subarachnoid haemorrhagic stroke the corresponding HRs were 2.62 (95% CI 1.22 to 5.64), 3.03 (95% CI 1.49 to 6.18) and 1.83 (95% CI 0.87 to 3.83), respectively. Results of 10-year mortality showed similar patterns, although the association of deprivation with 1-year mortality was not significant. CONCLUSIONS: There is a significant impact of SED on long-term mortality after haemorrhagic stroke. The reasons for this survival inequality must be explored to reduce mortality in patients with haemorrhagic stroke.

Association between socioeconomic deprivation and functional impairment after stroke: the South London Stroke Register.

BACKGROUND AND PURPOSE: Previous findings of the association between socioeconomic deprivation and functional impairment after stroke are inconsistent. There is a lack of data on long-term association. We assessed the association and differences by age, sex, prestroke comorbidities, and stroke phenotypes. METHODS: We examined data from the South London Stroke Register cohort of 1995 to 2011, recording all first-ever strokes in patients of all ages in South London. A total of 2104 patients were alive at 3 months after stroke. Socioeconomic deprivation was measured using the index of multiple deprivation based on patient postcodes, and functional impairment after stroke was defined as a Barthel index of <15. RESULTS: At 3 months after stroke, 643 patients had functional impairment (30.6%; 95% confidence interval, 28.6%-32.5%). Compared with the first quartile of index of multiple deprivation (the least deprived), multivariate-adjusted odds ratios for functional impairment in patients with the second, third, and fourth quartiles were 1.29 (95% confidence interval, 0.94-1.76), 1.33 (0.97-1.82), and 1.78 (1.31-2.43), overall P=0.004. The association was significant in patients aged ≥65 years (corresponding odds ratios were 1.49 [1.02-2.17], 1.21 [0.83-1.75], and 1.94 [1.34-2.81]; P=0.003); in women, P=0.008, in patients who do not have prestroke comorbidities, P=0.009, and in patients with ischemic stroke, P<0.001, but not significant in their counterpart patients. There were similar patterns of the associations of socioeconomic deprivation with impairment at 3 years after stroke. CONCLUSIONS: There are significant inequalities in short- and long-term functional recovery after stroke. General socioeconomic improvement, targeting groups at high risk of functional impairment is likely to reduce inequality in functional recovery after stroke.

Socioeconomic deprivation and survival after stroke: findings from the prospective South London Stroke Register of 1995 to 2011.

BACKGROUND AND PURPOSE: Previous findings of the association between socioeconomic deprivation (SED) and survival after stroke are inconsistent. There is less investigation on long-term survival. We assessed the associations in a multi-ethnic population in England. METHODS: We examined data from 4398 patients (3103 whites, 932 blacks, and 253 Asians/others) with first-ever stroke, collected by a population-based stroke register in South London from 1995 to 2011. SED was measured using the Carstairs index score-the higher score, the more deprived. It was analyzed in multivariate Cox regression models in relation to survival after stroke. RESULTS: During 17-year follow-up 2754 patients died. The quartile data of Carstairs score showed no significant association of SED with survival in patients, except for black Caribbeans and Africans. Black patients with the fourth quartile SED had a multivariate adjusted hazard ratio of 1.76 (95% confidence interval, 1.06-2.94) for 3-month mortality and 1.54 (1.00-2.37) for 1-year mortality. After adjustment for acute stroke care provisions, these were no longer significant. However, the sextile data of Carstairs score showed a consistent association of SED with survival after stroke; all patients with the sixth sextile had a fully adjusted hazard ratio of 1.23 (1.05-1.44) for 3-month mortality and 1.13 (1.01-1.25) for 17-year mortality. CONCLUSIONS: There is a weak but significant association of SED with reduced survival after stroke in England. SED in blacks may have a stronger impact on short-term survival when compared with white patients. Further efforts are required to achieve equality in survival among patients with stroke of different socioeconomic groups.