We sought to assess the differential impact of Allostatic load (AL) on cognitive outcomes after intracerebral hemorrhage (ICH) across race-ethnicity.

Post-stroke functional decline, including cognition, has been shown to be worse in Black vs White patients, even after adjusting for demographic, comorbidity, and health care access variables. There is a need to close this knowledge gap by investigating novel factors that may contribute to stroke outcome disparities. AL is the lifetime adverse physiologic impact of needing to adjust to socially structured stressors such as racism. AL has been shown to increase health vulnerability in marginalized populations, but has never been applied to stroke.

The Intracerebral Hemorrhage Outcomes Project (ICHOP) prospectively collected data from patients presenting to Columbia Medical Center with ICH from 3/2009 to 5/2016. Data included demographics, stroke scores, labs, complications, neuroimaging, medical history, and discharge data. Ten markers of AL (BMI, A1c, SBP, TG, CRP, HDL, LDL, HGB, HR, ALB) were obtained. An AL score was generated by summing the elements in each patient that fell outside normal ranges, with AL score ranging 0-10. Linear regression models were used to evaluate the relationship between AL and Telephone Interview for Cognitive Status (TICS) at discharge in the entire population, and then stratified by race-ethnicity.

Among 248 White, 195 Black, and 261 Hispanic ICH patients, neither mean AL nor mean TICS differed by race/ethnicity (p=0.55, p=0.21 respectively). In the overall ICHOP cohort AL was associated with TICS at discharge (p=0.043). In Whites and Hispanics AL was not associated with TICS at discharge (p=0.725, p=0.33 respectively). In Black patients, higher AL was associated with a decrease in TICS at discharge (p=0.016).

AL is an important determinant of post ICH outcomes for certain minority populations. AL may explain some of the unexplained health disparities in stroke populations.