Abstract WP164: Social Determinants of Health and Functional and Psychological Outcomes After Hemorrhagic Stroke

Introduction: Patients who have had hemorrhagic strokes experience psychological and functional deficits after hospital discharge. Social Determinants of Health (SDoH) can also impact outcomes. The relationship between SDoH and psychological outcomes following hemorrhagic stroke has not been well studied.

Methods: This is a prospective cohort study including patients ≥18-years-old hospitalized in Manhattan for non-traumatic hemorrhagic stroke, including intracerebral hemorrhage (ICH) and subarachnoid hemorrhage, between 2015 and 2022, aiming to determine the relationship between SDoH, functional and psychological outcomes. SDoH were reported on admission by patients or their surrogate, and included education level, occupation, insurance, marriage status, median household income (MHI) by zip code, and race/ethnicity. Questionnaires for the Barthel Index and Quality of Life in Neurological Disorders (T-score >50 abnormal) were completed at 3 and 12 months. Pearson’s Chi-Square and Mann Whitney U test were used to explore the relationship between SDoH and abnormal psychological outcomes.

Results: We identified 120 patients with hemorrhagic stroke that had follow up psychological outcome testing. The median age [interquartile range (IQR)] was 64 [51-75], 46% female, median ICH score [IQR] was 1 [0-2], median Hunt-Hess scale [IQR] was 2[1-3]. Patients whose highest level of education was high school or below (21% of the cohort) were more likely to be dependent than independent with activities of daily living (33% vs 8%, p≤0.01) at 3 months. The median MHI by zip code [IQR] was $90,306 [$68,220-$131,038]. Patients with impaired communication were more likely to be from areas with lower MHI ($57,770 [$56,572-$68,221] vs. $90,871 [$72,895-$129,705], p=0.01) at 3 months. Employed patients (49% of cohort) were more likely to have cognitive executive dysfunction at both 3 (71% vs 39%) and 12 months (70% vs 34%, p<0.01 for both). Employed patients were also less likely to report overall good well-being (61% vs 29% at 3 months, 61% vs 20% at 12 months, p<0.01 for both).

Conclusion: Psychological and functional outcomes for patients with hemorrhagic strokes are associated with SDoH. Interventions specifically addressing SDoH should be considered.