Leah Kleinberg1, Santiago Clocchiatti-Tuozzo1, Cyprien Rivier1, Victor Torres-Lopez1, Jisoo Kim1, Eva Kitlen1, Michael Kampp1, Sara Jasak1, Joseph Schindler1, Lauren Sansing1, Kevin Sheth1, Guido Falcone1
1Yale University, Department of Neurology
Objective:
To test the hypothesis that neighborhood deprivation leads to unfavorable long-term functional outcomes following acute ischemic stroke (AIS).
Background:
The association between neighborhood deprivation and the risks of disease and mortality among ischemic stroke patients is well-documented. However, the role of neighborhood deprivation in long-term outcomes following acute brain injury remains understudied.
Design/Methods:
We conducted a nested study within a prospective longitudinal study following patients with acute brain injury admitted to Connecticut’s largest health system. This study focused on AIS survivors and assessed neighborhood deprivation using the Area Deprivation Index (ADI), a metric using 9-digit zip codes to rank neighborhoods based on income, employment, education, and housing quality. Patients were stratified into tertiles based on their ADI, designated as low, intermediate, or high deprivation. Functional outcomes were evaluated using the modified Rankin Scale at one-year post-stroke, dichotomized into favorable (0-2) and unfavorable (3-6) scores. Our analysis employed multivariable logistic regression for adjusted analyses.
Results:
Among 2,540 AIS patients enrolled between 2018 and 2021, 1,898 patients had zip code and outcomes data (mean age 70 years, 48% female, 17% Black, 7.0% Hispanic). The one-year unadjusted risk of poor outcomes was 40.0%, 42.8%, and 49.2% for patients residing in neighborhoods with low, intermediate, and high deprivation, respectively (unadjusted p=0.001). These findings remained significant in multivariate analyses that controlled for confounding factors including comorbidities and stroke severity. Compared to patients living in neighborhoods with low deprivation, those living in areas with intermediate and high deprivation had 39% (OR 1.39, 95% CI 1.09-1.77) and 97% (OR 1.98, 95% CI 1.54-2.54) greater risk of unfavorable outcomes (test-for-trend p<0.001).
Conclusions:
Our study underscores the connection between neighborhood deprivation and an elevated risk of unfavorable outcomes. We validate the utility of the ADI as an analytical tool for evaluating neighborhood deprivation as a composite for several social determinants of health.