NEW YORK (Reuters Health) - Lower-income stroke patients in Canada are more likely to die and less likely to receive rehabilitative services than their wealthier counterparts despite a system in which citizens have universal access t'o healthcare, researchers report.

The findings show that even in a country with a national health insurance program, a person's socioeconomic status can influence the type of medical care he or she receives.

``I would expect the impact of socioeconomic status on stroke mortality to be at least as great, and probably greater, in a country without universal health coverage,'' said Dr. Moira K. Kapral from Toronto General Hospital in Ontario, Canada, in an interview with Reuters Health.

According to the report on nearly 39,000 patients, whose average age was 74, those from lower-income neighborhoods were more likely to die one month and one year after their stroke regardless of their age and other medical conditions. They were also less likely to receive rehabilitative services such as physiotherapy, occupational therapy and speech therapy, to be cared for by a neurologist and to receive diagnostic imaging procedures such as CT scan and MRI, results from the 3-year study show.

However, roughly 60% of all patients received antiplatelet medication or warfarin regardless of income. Similarly, there was no difference in the percentage of patients who underwent carotid endarterectomy, a procedure in which doctors clear plaque from a key artery to improve blood flow to the brain, although waiting times for the surgery were significantly longer for poorer patients. There was also no difference in the length of hospital stay, Kapral and colleagues report in the January issue of Stroke: Journal of the American Heart Association.

``Stroke patients with lower socioeconomic status had increased mortality and decreased access to some healthcare resources, despite a goal of universal access to healthcare for all Canadian citizens,'' Kapral's team reports.

While it is not clear why patients from lower-income neighborhoods would have worse access to certain medical services in Canada, the researchers suggest that specialized resources may be unevenly distributed.

``Wealthier neighborhoods may be more attractive for specialist physicians to locate in and may also be more effective in lobbying the government for advanced medical technologies for their neighborhood hospitals,'' the authors write.

Others suggest that higher income may translate into improved compliance with medication, less stress and better living conditions, factors that can all ultimately affect the risk and severity of stroke.

``In addition...neighborhood or community environments may provide additional pressures including poverty, pollution, violence, and isolation, which may increase stroke risk and produce poorer stroke outcomes,'' Bernadette Boden-Albala and Dr. Ralph L. Sacco, from Columbia University in New York City, write in an accompanying editorial.

SOURCE: Stroke 2002;33:268-275.

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