Jisoo Kim1, Eva Kitlen1, Victor Torres-Lopez1, Cyprien Rivier1, Daniela Renedo1, Maia Schlechter1, Leah Kleinberg1, Melissa Pish1, Michael Kampp1, Sara Jasak1, Lauren Sansing1, Kevin Sheth2, Guido Falcone3
1Yale University, 2Yale UniversityDivision of Neuro and Critical Care, 3Yale School of Medicine
Objective:
We aimed to determine if neighborhood disadvantage is associated with poor outcomes following intracerebral hemorrhage (ICH).
Background:
Neighborhood disadvantage uniquely captures numerous social and environmental exposures. There is mounting evidence linking social determinants to various health outcomes.
Design/Methods:
We conducted a nested study within an ongoing longitudinal study that prospectively follows patients with brain injury within Connecticut’s largest healthcare system. The nested study included ICH survivors and evaluated neighborhood deprivation using the Area Deprivation Index (ADI), a publicly available metric that ranks neighborhoods’ disadvantage based on numerous factors. Patients were given an ADI tertile designation: low, intermediate, and high deprivation. Initial ICH severity was defined with admission GCS. Outcome was evaluated through the discharge and 6-month post-ICH Modified Rankin Scale (mRS), dichotomized as 0-3 (good outcome) and 4-6 (poor outcome). We used chi-square tests and multivariable logistic regression for unadjusted and adjusted association analyses, respectively.
Results:
Out of 687 enrolled ICH patients, 518 (mean age 67, 47.5% female, 19% Black, 8% Hispanic) had 9-digit zip-code and outcomes data. Neighborhood disadvantage was not associated with admission GCS (adjusted p=0.59) or discharge mRS (adjusted p=0.95). However, at 6-months post-discharge, the risk of poor outcome was 28%, 44%, and 47% for patients in neighborhoods with low, intermediate, and high disadvantage (unadjusted p=0.02). Multivariable analyses adjusting for potential confounders confirmed these results: compared to low-disadvantage neighborhoods, those living in neighborhoods with intermediate and high disadvantage had 52% (OR 1.52, 95%CI 0.76-3.08) and 89% (OR 1.89, 95%CI 0.91-3.94) higher risk of poor outcomes (test-for-trend p=0.01).
Conclusions:
Among ICH patients enrolled in a prospective study of acute brain injury, higher neighborhood disadvantage was associated with a higher risk of poor outcomes 6-months post-ICH but not with admission or discharge clinical status. These results suggest that the numerous factors captured by the ADI influence these subjects’ complex post-discharge evolution.