Abstract WMP47: Neighborhood Socio-Economic Status as a Predictor of All-Cause Long-Term Post-Stroke Mortality
Lisa Nobel, David Robinson, Robert J Stanton, Christopher Becker, Dawn O Kleindorfer, Kathleen Alwell, Lili Ding, Pooja Khatri, Opeolu M Adeoye, Simona Ferioli, Jason Mackey, Daniel Woo, Sharyl Martini, Felipe DeLosRiosLa Rosa, Stacie Demel, Tracy Madsen, Michael Star, Elisheva R Coleman, Kyle Walsh, Sabreena Slavin, Adam S Jasne, Eva Mistry, Mary Haverbusch, Brett M Kissela- Advanced and Specialized Nursing
- Cardiology and Cardiovascular Medicine
- Neurology (clinical)
Background: Previous studies have shown that neighborhood socioeconomic status may be associated with post-stroke mortality. However, these studies did not adjust for stroke severity. We aim to determine the association between neighborhood of residence on long-term mortality after stroke.
Methods: Within our population of 1.3 million in the Greater Cincinnati Northern Kentucky area, incident strokes among adult residents were ascertained at all area hospitals during calendar years 2005, 2010 and 2015. Participants addresses were used to geocode and determine their census tract and then used a validated index to determine neighborhood socio-economic status. We used national death index data to determine mortality status at 5 years post stroke. Individuals who survived at least 30 days were included in the analysis. We used cox proportional hazards to determine the association between neighborhood of residence deprivation and case fatality rate after stroke.
Results: Among 4514 incident ischemic strokes, there were 1719 deaths over 5 years; for an all-cause post-stroke mortality rate of 38.08% among survivors of 30 days post-stroke. Similarly, there were 552 intracerebral hemorrhages with 224 deaths over 5 years: yielding an all-cause post-stroke mortality rate of 40.58%. Individuals in the quartile of neighborhoods with lowest neighborhood socio-economic status had 1.3 times the all-cause post-stroke mortality rate (HR 1.29 95% CI 1.08-1.54); after adjustment for age sex, race, and year of study (2005, 2010 and 2015). After adjustment for age, race, sex, year of study and NIH stroke scale score, individuals living in the quartile of neighborhoods with the lowest neighborhood socio-economic status had 1.29 times the risk of dying (HR 1.29 95% CI 1.09-1.53). We found insufficient evidence of an association between neighborhood socio-economic status and 5-year case fatality rate among intracerebral hemorrhages.
Conclusion: Rates of all-cause post-stroke long-term mortality were higher among patients with ischemic stroke who lived in neighborhoods with lowest quartile of socio-economic status. This effect persisted even after adjusting for stroke severity.