Objective:

The aim of this study is to understand the social determinants of health within our public safety net hospital. This is a descriptive study to evaluate demographics in patients treated with IV thrombolysis in relation to social determinants of health (SDOH).

Background:

The management of acute ischemic stroke over the last three decades has seen an expansive progression in terms of medical and surgical interventions. Stroke outcomes continue to be reliant on factors only attributable to the patient. 

Design/Methods:

All patients entered into the GWTG-Stroke registry for NYC Health+Hospitals/Kings County between 3/1/2022 and 3/31/2024. Any patients whose symptoms started after hospital arrival, were transferred to or from another hospital, or had unknown last known well were excluded. Chi-Square tests and logistic regressions were performed.

Results:

Between 3/2022 and 3/2024, 1359 patients were analyzed and 141 patients were identified to have at least 1 SDOH. Comparing age, patients aged 80+ were likely to have at least 1 SDOH compared to patients aged less than 50 years old (2.31, 1.21-4.42, p<0.02). Compared to patients with resolution of symptoms, those symptoms persisted are more likely to have at least 1 SDOH (1.78, 1.04-3.06, p<0.04). Patients using Medicare/Medicaid are more likely to have at least 1 SDOH compared to those with private insurance (2.19, 1.26-3.82, p<0.01). In logistic regression model, only age (1.02, 1.01-1.04, p<0.02) and payment source (1.79, 1.01-3.16, p<0.05) were statistical predictors of a patient reporting SDOH.

Conclusions:

Factors have been demonstrated to be associated with social barriers to optimal stroke care. Medicaid/Medicare insurance status has been associated with readmissions and higher mortality than other patients.  This can be attributed to lower health literacy, thereby preventing accessing medical care.
By addressing SDOH, we hope to provide comprehensive stroke care to not only identify high risk patients, but also optimize care for patients within the healthcare system.