PT  - JOURNAL ARTICLE
AU  - Stulberg, Eric L.
AU  - Twardzik, Erica
AU  - Kim, Sehee
AU  - Hsu, Chia-Wei
AU  - Xu, Yuliang
AU  - Clarke, Philippa
AU  - Morgenstern, Lewis B.
AU  - Lisabeth, Lynda D.
TI  - Association of Neighborhood Socioeconomic Status With Outcomes in Patients Surviving Stroke
AID  - 10.1212/WNL.0000000000011988
DP  - 2021 May 25
TA  - Neurology
PG  - e2599--e2610
VI  - 96
IP  - 21
4099  - http://n.neurology.org/content/96/21/e2599.short
4100  - http://n.neurology.org/content/96/21/e2599.full
SO  - Neurology2021 May 25; 96
AB  - Objective To examine associations between neighborhood socioeconomic status (nSES) and 90-day poststroke outcomes.Methods The Brain Attack Surveillance in Corpus Christi Project is a population-based surveillance study in Nueces County, Texas. Patients with strokes were identified between 2010 and 2016 via active and passive surveillance and enrolled in the study. nSES index is a standardized composite of 2010 Census tract–level income, wealth, education, and employment (median −4.56, interquartile range −7.48 to −0.46). The 90-day outcomes were ascertained via interview: functional status measured by the average of 22 activities of daily living/instrumental activities of daily living (range 1–4), biopsychosocial health by the Stroke-Specific Quality of Life scale (range 0–5), and depressive symptoms by the 8-item Patient Health Questionnaire (range 0–24). Associations between nSES and outcomes were estimated using confounder-adjusted generalized estimating equations with an nSES × NIH Stroke Scale score interaction term.Results Seven hundred seventy-six survivors made up the analytical sample (52.96% male, 62.24% Mexican American, 52.96% ≥64 years old). Higher compared to lower nSES (mean difference comparing 75th to 25th percentile of nSES) was associated with better function (−0.27, 95% confidence interval [CI] −0.49 to −0.05), better biopsychosocial health (0.26, 95% CI 0.06–0.47), and fewer depressive symptoms (−1.77, 95% CI −3.306 to −0.48) among those with moderate to severe strokes. Among those with minor strokes, higher nSES was associated with better function (−0.13, 95% CI −0.24 to −0.02).Conclusions nSES may influence poststroke recovery. Studies should identify neighborhood characteristics that contribute to poststroke outcomes, particularly in moderate to severe stroke survivors.ADL=activities of daily living; BASIC=Brain Attack Surveillance in Corpus Christi; CI=confidence interval; IADL=instrumental ADL; ICF=International Classification of Functioning, Disability, and Health; NIHSS=NIH Stroke Scale; nSES=neighborhood socioeconomic status; PHQ-8=Patient Health Questionnaire Eight; SS-QOL=Stroke-Specific Quality of Life