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OBJECTIVE: To determine if there is a correlation between socioeconomic conditions and in-hospital mortality (IHM) from ischemic stroke in a sample of the Colombian population and identify the chain of events that determine that association. METHODS: Prospective study of a hospital cohort of patients with ischemic stroke in four Colombian clinical referral institutions-located in Floridablanca, Bucaramanga, Bogotá, and Medellín-between February 2003 and December 2006. Hierarchical analysis was used to group the socioeconomic variables into three levels, and their relationship to IHM due to ischemic stroke was assessed in a Cox proportional hazards model. RESULTS: The IHM rate was 9.4% in the 253 patients included in the study. In the analysis by levels, mortality was inversely associated with educational level (advanced to primary), monthly income (≥ minimum wage), and participation in the contributory health system. When the three levels were combined in the hierarchical analysis, affiliation with the contributory system was the only association that maintained its statistical significance (RR 0.35; CI 95%: 0.13-0.96; P = 0.04). CONCLUSIONS: The results indicate that, in Colombia, being affiliated with the contributory health system is an independent protective factor against IHM after an ischemic stroke. The education-income-access to health services sequence is a possible explanation for the relationship between socioeconomic conditions and the clinical outcome of these events. Strategies should be designed to mitigate the differences in the quality and distribution of health services in the Colombian population.

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OBJETIVO: Determinar si existe asociación entre las condiciones socioeconómicas y la mortalidad intrahospitalaria (MIH) por accidente cerebrovascular (ACV) isquémico en una muestra de población colombiana e identificar la cadena de eventos que determinan esa asociación. MÉTODOS: Estudio prospectivo de una cohorte hospitalaria de pacientes con ACV isquémico registrados en cuatro instituciones clínicas de referencia colombianas -ubicadas en Floridablanca, Bucaramanga, Bogotá y Medellín- entre febrero de 2003 y diciembre de 2006. Mediante análisis jerárquico se evaluaron las variables socioeconómicas agrupadas en tres niveles para determinar su relación con la MIH por ACV isquémico en un modelo de riesgos proporcionales de Cox. RESULTADOS: En los 253 pacientes incluidos, la MIH fue de 9,4 %. En el análisis por niveles, la mortalidad estuvo inversamente asociada con el nivel educacional (estudios superiores a primaria), los ingresos mensuales (≥ salario mínimo) y la vinculación al régimen contributivo. En el análisis jerárquico, al combinar los 3 niveles, solo la asociación inversa con la afiliación al régimen contributivo mantuvo su significación estadística (RR 0,35; IC95%: 0,13-0,96; P = 0,04). CONCLUSIONES: Los resultados indican que en Colombia, el estar afilado al régimen contributivo de salud es un factor protector independiente contra la MIH tras un ACV isquémico. La secuencia educación-ingresos-acceso a servicios de salud constituye una vía de explicación de la relación entre las condiciones socioeconómicas y el desenlace clínico de estos eventos. Se deben diseñar estrategias para mitigar las diferencias en la calidad y la distribución de los servicios de salud en la población colombiana.

OBJECTIVE: To determine if there is a correlation between socioeconomic conditions and in-hospital mortality (IHM) from ischemic stroke in a sample of the Colombian population and identify the chain of events that determine that association. METHODS: Prospective study of a hospital cohort of patients with ischemic stroke in four Colombian clinical referral institutions-located in Floridablanca, Bucaramanga, Bogotá, and Medellín-between February 2003 and December 2006. Hierarchical analysis was used to group the socioeconomic variables into three levels, and their relationship to IHM due to ischemic stroke was assessed in a Cox proportional hazards model. RESULTS: The IHM rate was 9.4% in the 253 patients included in the study. In the analysis by levels, mortality was inversely associated with educational level (advanced to primary), monthly income (≥ minimum wage), and participation in the contributory health system. When the three levels were combined in the hierarchical analysis, affiliation with the contributory system was the only association that maintained its statistical significance (RR 0.35; CI 95%: 0.13-0.96; P = 0.04). CONCLUSIONS: The results indicate that, in Colombia, being affiliated with the contributory health system is an independent protective factor against IHM after an ischemic stroke. The education-income-access to health services sequence is a possible explanation for the relationship between socioeconomic conditions and the clinical outcome of these events. Strategies should be designed to mitigate the differences in the quality and distribution of health services in the Colombian population.

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Introducción. El sobrepeso y la obesidad han sido postulados como factores de riesgo para enfermedad coronaria, sin embargo, los estudios epidemiológicos han mostrado resultados contradictorios acerca de la asociación de estos factores con el riesgo de desarrollar enfermedad cerebrovascular isquémica aguda (ECV). Materiales y métodos. La presente investigación es un subanálisis del análisis nacional multicéntrico de casos y controles para el estudio Factores de riesgo de enfermedad cerebrovascular isquémica en Colombia (FREC-VI). Se incluyó una muestra de 253 pacientes con diagnóstico confirmado de ECV y 253 controles. Se propuso como objetivo evaluar la asociación entre la obesidad y el sobrepeso con el riesgo de desarrollar ECV isquémica aguda ajustando por la presencia de posibles factores confusores, mediante la aplicación de una regresión logística múltiple. Resultados. Los casos presentaron una media menor de IMC (24,90 ± 3,77 kg/m2 vs. 25,87 ± 4,25 kg/m2; p = 0,0091), además de una menor proporción de obesidad (7,51% vs. 15,05%; p = 0,010) en comparación con los controles. En el análisis crudo la obesidad mostró tendencia hacia la asociación como factor protector, no obstante, al realizar el ajuste mediante el análisis multivariado tanto el sobrepeso como la obesidad no mostraron significancia. Conclusiones. La presencia de sobrepeso u obesidad no mostró asociación con el hallazgo de ECV isquémica aguda en una muestra de población colombiana.

Introduction. Overweight and obesity have been postulated as risk factors for coronary arterial disease, howeverepidemiological studies have shown conflicting results about the association of these factors with the risk ofdeveloping cerebrovascular disease. Materials and methods. The present study is a sub-analysis of the national multicenter Case-Control Study of RiskFactors for ischemic stroke in Colombia “FREC-VI”. A sample of 253 patients with confirmed diagnosis of ischemicstroke and 253 controls was included. The study aim was to assess the association between obesity and overweight with the risk of developing ischemic stroke adjusting for possible confounding factors. Results. Cases had a lower BMI (24.90 ± 3.77 kg/m2 vs 25.87 ± 4.25 kg/m2; p = 0.0091), and a lower proportion of obesity (7.51% vs 15.05%; p = 0.01) compared with controls. The crude analysis showed a tendency of obesity as a protectivefactor, however, after adjustment by other covariates, both overweight and obesity lost their significance. Conclusion. Overweight and obesity are not associated with acute ischemic stroke in Colombian population.

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