To determine if greater residential distance from hospital and lower median household income are associated with worse outcomes among stroke patients aged 18-50. 

Prior research has focused on geographic and financial barriers to stroke care, however, is limited in young adults. Understanding geography and socioeconomic influences on outcomes may identify targets for intervention.

We retrospectively analyzed patients aged 18–49 admitted with stroke to a large urban safety-net hospital (2013–25). Home zip-codes were used to estimate distance to hospital (<5 miles = local, >15 miles = distant) and median household income quintiles via U.S. Census. We vascular risk factors and presentation timing as well in-hospital mortality and discharge modified Rankin Scale (mRS) in relation to income, distance, and transport mode. Chi-square, t-tests, and correlations assessed associations between amongst these parameters (α = 0.05).

15% of 791 patients lived within 5 miles of the hospital. Only 32% of the cohort arrived within 4.5 hours of symptom onset. Mortality was 7.2%, with a nonsignificant trend toward higher mortality among distant (8.8%) versus local (6.8%) patients (p = 0.11). Poor outcomes (mRS 4–6) trended with distance (16.1% (local) and 21.4% (distant)) and modestly with income (p > 0.05). Lower-income patients tended to live farther away (r = 0.30, p < 0.001). Hypertension (p < 0.0001), diabetes (p = 0.044), and smoking (p = 0.001) were more prevalent near hospital, while hypertension (p = 0.002) and diabetes (p = 0.017) highest in lowest income quintile. Transport mode was significantly associated with mortality (χ² = 17.47, p = 0.001), with private transport being the lowest (2.1%).

Socioeconomic and geographic factors influence outcomes after stroke in the young, as trends suggest poorer recovery in lower-income or distant patients. Future studies should incorporate more specific data rather than zip-code proxy to understand causes of disparity.