2025 American Academy of Neurology Abstract Website

Objective:

Investigating poverty and mortality after stroke.

Background:

Social determinants of health (SDOH) are drivers of inequities after stroke. Recently, the National Advisory on Neurological Disorders and Stroke Council developed the NINDS SDOH Framework for Addressing Health Inequities, which depicts the interplay between structural, intermediate, intrapersonal and biological determinants of health. It is unclear to what extent poverty is associated with stroke outcomes, independent of other SDOH.

Design/Methods:

Among individuals over 18 with self-reported history of stroke who participated in the National Health and Nutrition Examination Surveys from 2005 through 2018, we assessed the association between poverty and mortality. The Department of Health and Human Services issues poverty benchmarks, which account for family size and geographic location (poverty income ratio [PIR] 100% = federal poverty level). Four multivariate models were used to determine the association between poverty (PIR <200%) and all-cause mortality after stroke: (1) adjusted for age, sex, race, ethnicity, nativity, education, employment (2) adjusted for intermediate determinants (food security, healthcare access, insurance, marital status, housing) (3) adjusted for intrapersonal determinants (acculturation, disability, English proficiency, depression, diet, physical activity) and (4) adjusted for biological determinants (hypertension, diabetes, obesity, hypercholesterolemia, Charlson Comorbidity Index).

Results:

Among 1591 survivors, 880 (47%) had a PIR < 200%. Poverty was associated with 40% increased odds of mortality after stroke in the unadjusted model (HR 1.432, 95% CI 1.136-1.805). After adjustment for demographic, structural, and social status determinants, individuals with a PIR < 200% were 1.4 times more likely to experience all-cause mortality (HR 1.41, 95% CI: 1.12–1.78). Results remained significant after adjusting for intermediate (HR 1.40, 95% CI: 1.10–1.79), intrapersonal (HR 1.35, 95% CI: 1.06–1.72), and biological factors (HR 1.39, 95% CI: 1.08–1.79).

Conclusions:

Poverty is independently associated with higher mortality after stroke, suggesting that addressing income disparities through interventions like guaranteed income programs could improve outcomes.