Abstract Details

Title Neighborhood income inequality associated with functional independence after ischemic stroke: a cohort study

Topic Health Care Disparities

Presentation(s) S28 - Health Care Disparities (2:12 PM-2:24 PM)

Poster/Presentation
Number 007

Objective We examined associations between income inequality and post-stroke disability among stroke survivors in Massachusetts, where high levels of income inequality are reported. We hypothesized that increased neighborhood income inequality (measured by Gini index) may be associated with a slower recovery after stroke.

Background Individual measures of socioeconomic status are associated with post-stroke disability in patients with ischemic stroke. However, it is not known whether the distribution of income in a community may have an impact on stroke recovery.

Design/Methods This was a retrospective cohort study of adults hospitalized at a comprehensive stroke center with acute ischemic stroke between 1/1/2018-12/31/2019. Patient data was abstracted from the EHR and zip code Gini index was obtained from the US Census Bureau. Binary logistic regression was used to assess the relationship between Gini index and modified Rankin score at discharge and follow-up. Another binary regression was performed using a subset of patients in order to assess possible predictors of being discharged as recommended.

Results 337 patients were included in this analysis. Zip code Gini index was not associated with functional independence at discharge but was associated with independence at follow-up. Patients from high inequality neighborhoods were less likely to be independent. Being discharged as recommended was associated with a higher likelihood of independence at follow-up. Greater income inequality and Asian race were associated with a lower likelihood of being discharged as recommended.

Conclusions Among a cohort of patients with ischemic stroke, increased neighborhood income inequality was associated with a lower likelihood of functional independence at the time of outpatient follow-up. Each 1% increase in neighborhood Gini index decreased the likelihood of independence at follow-up by 8%. Patients living in the highest inequality neighborhood were 250% less likely to achieve independence compared to those in the lowest inequality neighborhood. This disparity may be driven by discharge destination and race.

Authors/Disclosures
Kathryn Cote, MPH PRESENTER	Ms. Cote has nothing to disclose.
Megan E. Pudlo (Tufts University School of Medicine)	Ms. Pudlo has nothing to disclose.
	No disclosure on file
Lester Y. Leung, MD (Tufts Medical Center)	Dr. Leung has received research support from NIH.

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