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

Bibliographic Data

ID22083035
AuthorsDevi Rita Rochemont, Devi Rochemont (0000-0002-4760-9986, Centre Hospitalier Andrée Rosemon), Emmanuelle Mimeau (Centre Hospitalier Andrée Rosemon), Caroline Misslin (0000-0002-4732-8180, University of French Guiana), Martine Papaix-Puech (Guiana Space Centre), Bertrand de Toffol (0000-0002-2006-631X, Centre Hospitalier Andrée Rosemon), Nadia Sabbah (0000-0002-7789-6728, Centre Hospitalier Andrée Rosemon), Emmanuel Delmas (Inserm), Yannick Bejot (0000-0001-7848-7072, Université de Bourgogne), Isabelle Fournel (0000-0002-3061-9715, Université de Bourgogne), Mathieu Nacher (0000-0001-9397-3204, University of French Guiana, corresponding author)
Year2022
Volume10
Pages849036-849036
Publication date2022-05-13
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueFrontiers in Public Health (JOURNAL)
Journal identifiersISSN: 2296-2565 • E-ISSN: 2296-2565
PublisherFrontiers Media SA (PUBLISHER • CH)
DOI10.3389/fpubh.2022.849036
PMID35646768
OpenAlexW4280561839
LanguageEN
Citations received4
References cited20

Background In 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. Methods A 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. Results Overall, 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. Conclusion Precariousness 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

Atrial fibrillation · Diabetes mellitus · Prospective cohort study · Acute Ischemic Stroke Management · Demography · Global Public Health Policies and Epidemiology · Medicine · Migration, Identity, and Health · Epidemiology · Internal Medicine · Pediatrics

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