The Association of Social Determinants of Health on Functional Outcome After Intracerebral Hemorrhage
Taylor McVeigh1, Pamela Rist2, Akashleena Mallick1, Samantha Mora1, Christina Kourkoulis1, Christopher Anderson2, Jonathan Rosand1, Nirupama Yechoor1
1Massachusetts General Hospital- Harvard Medical School, 2Brigham and Women's Hospital
Objective:
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Background:

It remains unknown which social determinants of health (SDOH) are impactful or when disparities begin to emerge in intracerebral hemorrhage (ICH). This study aimed to investigate the association between pre-stroke SDOH and post-stroke functional outcome.

Design/Methods:

Data from the Massachusetts General Hospital (MGH) ICH cohort was used and included age, sex, ICH severity, history of hypertension, tobacco use, diabetes, coronary artery disease, atrial fibrillation, liver disease, history of dementia, and history of prior ICH. SDOH exposures included income bracket, educational attainment, marital status, race, and religion. The primary outcome was the 12-month modified Rankin Score (mRS). 

Baseline characteristics, past medical history, and SDOH of mild stroke versus severe stroke were compared using the Wilcoxon Rank Sum test and chi-square tests. Factors associated with stroke severity (p<0.05) were included in a logistic regression model.

Results:

Of the 315 patients with 12-month mRS, 180 (57%) had scores <3 or good functional outcomes and 135 (43%) had mRS scores >=3 or poor functional outcomes. The median age with low mRS was 69 compared to 76 with high mRS. Those with high mRS were more likely to have high school-only education or diagnosis of dementia compared to low mRS. Those with high school-only education were 2.94 times more likely than college diplomates to have high mRS (OR 2.94, 95% CI 1.57-5.53). Similarly, those with a diagnosis of dementia were 6.22 times more likely to have high mRS (OR 6.22, 95% CI 1.70-22.75).

Conclusions:
Educational attainment was an independent predictor of poor functional outcome after ICH. We recognize the impact of survival bias in our study design; however, we found differences in recovery despite this bias. Our findings suggest that disparities in outcomes exist even in relatively homogenous patient populations and that SDOH prior to an ICH still have associations with functional outcomes after stroke. 
10.1212/WNL.0000000000206361