Patients living in disadvantaged neighborhoods have worse stroke recovery outcomes

Key takeaways:

• The study examined 2,164 adults with acute ischemic stroke from the Yale Health System.
• The one-year unadjusted risk for poor recovery outcomes were 35%, 40% and 46% in low, intermediate and high deprivation areas.

Individuals who suffered acute ischemic stroke in disadvantaged neighborhoods had twice the risk of poor recovery compared with those living in areas with improved conditions, according a speaker at the International Stroke Conference.

“The association between neighborhood deprivation and risk of disease is well-documented,” Leah M. Kleinberg, BA, a postgraduate associate at Yale University School of Medicine, said in her presentation. “However, the role of neighborhood deprivation in long-term outcomes following acute brain injury remains understudied.”

Kleinberg and colleagues sought to test the hypothesis that location of residence is associated with unfavorable long-term functional outcomes following acute ischemic stroke (AIS).

Their study was conducted within the Yale Longitudinal Study of Acute Brain Injury, which follows patients with acute brain injury admitted to the Yale Health System. Researchers focused on AIS survivors and assessed neighborhood deprivation among this population using the Area Deprivation Index (ADI), a metric that uses 9-digit ZIP codes to rank neighborhoods based on income, employment, education and housing quality.

From an initial field of 2,540 individuals enrolled in the study between 2018 and 2021, 2,164 (mean age 69.0 years; 48% female) were suitable for analysis. They were stratified into tertiles (low, intermediate, high) based on ADI, while functional outcomes were evaluated via the modified Rankin Scale at 1-year post-stroke and divided into favorable (0 to 2) and unfavorable (3 to 6) scores.

According to results, the 1-year unadjusted risk of poor outcomes was 35%, 40% and 46% for low, intermediate and high deprivation areas, respectively. These findings remained significant in multivariate analyses that controlled for confounding factors, as compared to patients living in neighborhoods with low deprivation, those living in areas with intermediate and high deprivation had 44% (OR = 1.44, 95% CI: 1.11-1.86) and 107% (OR = 2.07, 95% CI: 1.58-2.72) greater risk of unfavorable outcomes.

“We did not expect a large disparity in outcomes, yet we found patients in the most economically disadvantaged areas were twice as likely to have unfavorable outcomes compared to patients in areas with less unemployment, better housing quality and higher income and education levels,” Kleinberg said in a related release.

Reference:

• Where you live may be associated with more successful stroke recovery. https://newsroom.heart.org/news/where-you-live-may-be-associated-with-more-successful-stroke-recovery?preview=7454&preview_mode=True. Published Feb. 1, 2024. Accessed Feb. 7, 2024.