Objective:

We aimed to measure the social determinants of early stroke severity (NIHSS)  and infarct growth rate (IGR) in anterior circulation large vessel occlusion (ACLVO)  stroke using the Area Deprivation Index (ADI). 

Background:

Socioeconomic status has been shown to affect the clinical outcome of neurological disease and stroke.  Early NIHSS and IGR are highly variable across patients with ACLVO stroke but their determinants  remain poorly understood. ADI data incorporates housing, education, income, and employment status at the census block groups level. 

Design/Methods:

Single-center retrospective study of all patients with acute intracranial ICA or MCA occlusion and baseline CTP or MRI within 24 hours of stroke onset, from 2014-2017. IGR was calculated as the ischemic core volume / stroke onset to imaging time  (ml / h).  ADI was obtained from the University of Wisconsin dataset based on US Census data (v 3.2).  Demographics, co-morbidities, admission NIHSS, and median income data were collected.  Multivariable linear regression models tested the independent association between ADI and NIHSS (model 1) or IGR (model 2, including NIHSS).  

Results:

165 patients were included in the analysis, with mean age 71 (SD, 15), 40% male, median NIHSS 17 (IQR, 12-21), and mean ADI 62 (SD, 23.3).  In model 1, ADI (coefficient 0.07, 95% CI 0.025-0.13, P=0.004) and age (coefficient 0.11, 95% CI 0.4—0.19, P=0.003) were independently associated with NIHSS.  In model 2, ADI (coefficient 0.11, 95% CI 0.004-0.21, P=0.04) and NIHSS (coefficient 0.46, 95% CI 0.16-0.76, P=0.003) were independently associated with IGR. Median income, sex, diabetes or hypertension status were not associated with NIHSS or IGR in these models. 

Conclusions:

ADI is independently associated with worse stroke severity and faster infarct progression of ACLVO stroke.  These findings have potential implications for public health planning of stroke systems of care and enrollment in clinical trials of reperfusion therapies.