To examine disparities in demographics, comorbidities, and stroke severity among patients experiencing homelessness (PEH) compared with housed adults presenting with acute ischemic stroke.

Homelessness is a major social determinant of cerebrovascular health and is associated with premature aging, cardiovascular comorbidity, and early mortality. However, data on stroke characteristics and outcomes in PEH are limited.

Among 475 patients (mean age 64.9 ± 15.0), 78 (16%) were experiencing homelessness. PEH presented with stroke 9 years younger than housed patients (57.7 vs 66.7 years, p<0.001) and were predominantly male (72% vs 53%) and African American (68% vs 35%). They exhibited higher rates of substance use (49% vs 11%), smoking (53% vs 22%), and depression (26% vs 13%). Median initial NIHSS was higher in PEH (6 vs 4, p<0.05), and discharge mRS remained worse (median 3 vs 2, p<0.05). PEH were less likely to have a known “last known well” time (41% unknown; p=0.04) and less likely to receive intravenous thrombolysis (11.5% vs 17.1%). Mortality at discharge was numerically but not significantly higher in PEH (10.3% vs 7.8%), fewer PEH were discharged home (37% vs 53%), and more left against medical advice (9.0% vs 2.0%).