Living in poor neighborhoods linked to worse stroke recovery

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Stroke survivors living in areas with poor economic conditions were twice as likely to have a poor recovery, according to a preliminary study presented at the American Stroke Association’s International Stroke Conference 2024. Held in Phoenix, February 7-9, and is the world’s premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

This research was inspired by the people I work with every day. Although stroke patients of different socioeconomic backgrounds often have similar functional status at discharge, outcomes can vary dramatically one year later. As a clinical research associate, I can interact with them beyond the end of their emergency treatment, which sparks my interest in exploring the long-term outcomes of these patients.”

Leah Kleinberg, BA, is a postdoctoral clinical research associate in the Falcone Lab in the Department of Neurology at Yale School of Medicine in New Haven, Connecticut.

Kleinberg and colleagues found a significant association between functional outcomes after stroke and socioeconomic factors as noted by census block.

“The magnitude of this effect was most surprising. We did not expect a large disparity in outcomes, yet we found that patients from the most economically disadvantaged areas were twice as likely to have an adverse outcome than patients from areas with low unemployment, good housing standards and high income and education levels,” he said.

In this study, researchers used data from the Yale Longitudinal Study of Acute Brain Injury and Area Deprivation Index (ADI) rates in the 2020 US Census block to compare outcomes among stroke survivors by socioeconomic disadvantage factors. The ADI evaluates a neighborhood on levels of income, education, employment and housing quality and is specific to each ZIP code. It was developed by the US Health Resources and Services Administration to inform health care delivery and policy for underserved areas.

This analysis found:

  • Among 2,164 people with ischemic (clot-caused) stroke, the one-year inadequate risk of poor outcome for patients living in neighborhoods with low, intermediate, and high deprivation was 35%, 40%, and 46%, respectively.
  • After taking into account the inability of the ADI to specifically measure each level of deprivation, the researchers determined that those living in areas of moderate and high deprivation were 44% and 107% more at risk of adverse outcomes, respectively, than patients living in neighborhoods with low deprivation. layer
  • Patients in the poor outcome category were unable to look after their own affairs without assistance and required some help with their daily activities. In the good outcome category, patients can live independently, although some may have residual symptoms or disability.

“We hope that this research will help raise awareness of how social determinants of health are as important as clinical variables and health information when trying to identify patients who are at particularly high risk for poor long-term outcomes,” he said.

Study Details:

  • The Yale Longitudinal Study followed stroke survivors admitted to the Yale Health System, collecting outcome data at 3 months, 6 months, and then annually after hospital discharge. ZIP code data were available for 2,164 patients enrolled in the Yale Longitudinal Study between 2018 and 2021. The average age was 69; 48% were female; 7.5% were black adults and 7.7% were Hispanic adults.
  • Stroke outcome was determined by trained assessors using the modified Rankin scale, which measures the severity of disability after stroke on a scale of 0–6, from no disability (able to perform all tasks and responsibilities of daily living without assistance) to severe disability (bedridden). riding, incontinence, requiring constant nursing care and attention).

A limitation of the study is that the Area Deprivation Index depends on geographical blocks and does not assess each household separately. Also, due to the observational nature of the study, the results can only note associations and cannot determine cause and effect.

When considered separately from other cardiovascular diseases, stroke ranks fifth among all causes of death behind heart disease, cancer, COVID-19 and unintentional injuries/accidents, according to the American Heart Association’s Heart Disease and Stroke Statistics 2024 Update. The association also recognizes that considering the role of social determinants of health is essential to improving the cardiovascular health of all Americans.

“Access to quality care, nutritious food, stable housing or other basic health needs is critical for people recovering from stroke,” said Elizabeth A. Jackson, MD, MPH, FAHA, is a professor and director of the Association’s Committee on Social Determinants of Health and the Cardiovascular Outcomes and Performance Research Program at the University of Alabama at Birmingham, who was not involved in the study. “Unfortunately, these data are not surprising; rather, they support previous evidence that health disparities are disproportionately experienced in regions where high levels of social vulnerability exist.”

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