OBJECTIVES: To explore the role of ischemic stroke care-pathway on the association between education level and one-year survival after admission.   METHODS: From the Lazio health datawarehouse the incident hospitalizations for ischemic stroke in adults during 2011/12 were selected. For each subject the clinical history was defined by retrieving previous hospitalizations and drugs prescriptions. The association between education level and mortality after stroke was studied for acute (2-30 days from admission) and post-acute phase (31-365 days from discharge) using multivariate logistic and Cox models respectively. To identify different scenarios of quality care-pathway we considered hospital performance (in terms of 30-days mortality) for acute phase; access to rehabilitation and drug treatment post‑discharge (number of drugs among antihypertensives, antithrombotics, statins) for post-acute phase. The probability to survive to acute and post-acute phases according to education level and care-pathway scenarios were estimated for a “mean severity” patient assuming for this patient the same distribution of comorbidities as observed in the cohort. One-year survival probability was calculated as the product of two probabilities. For each scenario one-year probability ratio, university versus elementary, and its Bayesian confidence intervals [BCI95%] were calculated. RESULTS: We identified 9958 patients with ischemic stroke (mean age=76; 50% male), 53.3% with elementary education level and 3.2% with university. The mortality was 14.9% in acute phase and 15.7 per 100 person-years in post-acute phase among survivors. The adjusted mortality rates in acute and post-acute phase decreased with the increase of educational level (RR=0.90 p-trend<0.001; HR=0.85 p-trend<0.001). For the best care-pathway (hospital with high performance, access to rehabilitation, use of all three drugs) the one-year probability rate university versus elementary was 1.05 [BCI95%=1.03-1.08], while was 1.22 [BCI95%=1.12-1.32] for the worst care-pathway. CONCLUSIONS: The education level was negatively associated with mortality in acute and post-acute phases. The care-pathway reduces but not eliminates one-year survival inequity.