2025 American Academy of Neurology Abstract Website

Leroy Yankae¹, Aparna Nutakki², Melody Asukile³, Meron Awraris⁴, Sarah Braun¹, Lorraine Chishimba¹, Mashina Chomba³, Mataa Mataa¹, Dominique Mortel⁵, Chilando Mulenga¹, Dickson Munkombwe¹, Frighton Mutete¹, Naluca Mwendaweli⁶, Coolwe Namangala¹, Faith Simushi⁷, Stanley Zimba³, Deanna Saylor¹
¹University Teaching Hospital, Lusaka, ²Rush Medical College of Rush University, Chicago, IL, USA, ³University of Zambia School of Medicine, Lusaka, Zambia, ⁴Addis Ababa University, ⁵John Hopkins University School of Medicine, ⁶Levy Mwanawasa Teaching Hospital, ⁷Mazabuka General Hospital

Objective:

To evaluate the relationship between socioeconomic status (SES) and post-discharge stroke outcomes among Zambian adults with stroke.

Background:

Stroke is a leading cause of disability and death among adults, with the burden being worse in lower-middle income countries. Limited data exist on the association between SES and stroke outcomes in sub-Saharan Africa.

Design/Methods:

We conducted a prospective cohort study of consecutive adults with acute strokes in Zambia. Sociodemographic and clinical characteristics were obtained during their hospitalization. Surviving participants were called at 90-days post- discharge, and vital status and telephone modified Rankin Scale (mRS) were completed. Good outcomes, defined as mRS ≤2, and mortality were assessed in relation to SES indicators using multivariable logistic regression models.

Results:

Of 210 participants, 55% (n=135) were female, 60% (n=126) had ischemic strokes, and average age was 56+16 years. Good outcomes at 90 days occurred in 41% (n=86) while 90-day post-discharge mortality was 20% (n=42). Higher years of education attained (p<0.001), marital status (p<0.001), fewer adults residing with the patient (p=0.02), being in formal employment (p<0.001), and higher participant (p=0.08) and household (p=0.003) monthly incomes (p<0.003) were associated with good outcomes as were younger age, hyperlipidemia, and lower admission NIH Stroke Scale score. In multivariable analysis, unemployment (OR 0.34, 95%CI 0.12-0.95, p = 0.04) and being separated (OR 0.07, 95%CI 0.0006-0.97, p=0.048) were significantly associated with poor functional outcomes, as were age (p<0.001), and higher admission NIH Stroke Scale score (p<0.001) while hyperlipidemia (p=0.04) was associated with better outcomes. Only age (p=0.001) and admission NIH Stroke Scale score (p=0.001) were independently associated with mortality.

Conclusions:

SES indicators were not associated with higher risk of post-discharge mortality but were associated with functional outcomes. Patients with low SES require additional post-discharge supports to maximize their chances of a good functional outcomes.