Clinical Characteristics and Stroke Severity Among Patients Experiencing Homelessness Presenting With Acute Ischemic Stroke
Jennifer McKay1, Mihad Semir2, Sarah Meissner3, Behnam Sabayan3
1University of Minnesota Medical School, 2Neurology, Hennepin Healthcare Research Institute, 3Neurology, Hennepin County Medical Center
Objective:
To examine disparities in demographics, comorbidities, and stroke severity among patients experiencing homelessness (PEH) compared with housed adults presenting with acute ischemic stroke.
Background:
Homelessness is a major social determinant of cerebrovascular health and is associated with premature aging, cardiovascular comorbidity, and early mortality. However, data on stroke characteristics and outcomes in PEH are limited.
Design/Methods:
We conducted a retrospective cohort study of adults admitted with a primary diagnosis of acute ischemic stroke between January 2022 and December 2024 at Hennepin County Medical Center. Demographic, clinical, and outcome variables were extracted from the institutional stroke registry. Patients were categorized as experiencing homelessness or securely housed. Group comparisons and multivariate models were used to evaluate differences in stroke severity (NIHSS), disability (mRS), and use of acute stroke therapeutics.
Results:
Among 475 patients (mean age 64.9 ± 15.0), 78 (16%) were experiencing homelessness. PEH presented with stroke 9 years younger than housed patients (57.7 vs 66.7 years, p<0.001) and were predominantly male (72% vs 53%) and African American (68% vs 35%). They exhibited higher rates of substance use (49% vs 11%), smoking (53% vs 22%), and depression (26% vs 13%). Median initial NIHSS was higher in PEH (6 vs 4, p<0.05), and discharge mRS remained worse (median 3 vs 2, p<0.05). PEH were less likely to have a known “last known well” time (41% unknown; p=0.04) and less likely to receive intravenous thrombolysis (11.5% vs 17.1%). Mortality at discharge was numerically but not significantly higher in PEH (10.3% vs 7.8%), fewer PEH were discharged home (37% vs 53%), and more left against medical advice (9.0% vs 2.0%).
Conclusions:
PEH present with ischemic stroke nearly a decade earlier, have greater comorbidity burden, and stroke severity. Addressing these disparities through targeted prevention, timely recognition, and coordinated post-stroke care is essential to improve cerebrovascular outcomes in this high-risk population.
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