It remains unknown which social determinants of health (SDOH) are impactful or when disparities begin to emerge in intracerebral hemorrhage (ICH). This study aimed to investigate the association between pre-stroke SDOH and post-stroke functional outcome.

Data from the Massachusetts General Hospital (MGH) ICH cohort was used and included age, sex, ICH severity, history of hypertension, tobacco use, diabetes, coronary artery disease, atrial fibrillation, liver disease, history of dementia, and history of prior ICH. SDOH exposures included income bracket, educational attainment, marital status, race, and religion. The primary outcome was the 12-month modified Rankin Score (mRS). 

Baseline characteristics, past medical history, and SDOH of mild stroke versus severe stroke were compared using the Wilcoxon Rank Sum test and chi-square tests. Factors associated with stroke severity (p<0.05) were included in a logistic regression model.

Of the 315 patients with 12-month mRS, 180 (57%) had scores <3 or good functional outcomes and 135 (43%) had mRS scores >=3 or poor functional outcomes. The median age with low mRS was 69 compared to 76 with high mRS. Those with high mRS were more likely to have high school-only education or diagnosis of dementia compared to low mRS. Those with high school-only education were 2.94 times more likely than college diplomates to have high mRS (OR 2.94, 95% CI 1.57-5.53). Similarly, those with a diagnosis of dementia were 6.22 times more likely to have high mRS (OR 6.22, 95% CI 1.70-22.75).