Neighborhood income inequality associated with functional independence after ischemic stroke: a cohort study

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-09-24 DOI:10.1016/j.jstrokecerebrovasdis.2024.108035

Kathryn E. Coté MD, MPH, Megan E. Pudlo MD, Emma Jost-Price BA, Lester Y. Leung MD, MSc

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引用次数: 0

Abstract

Background

Individual measures of socioeconomic status have been associated with post-stroke disability in patients with ischemic stroke. However, it is not known whether the distribution of income in a community may have an impact on stroke recovery. We hypothesized that increased neighborhood income inequality (as measured by the Gini index) may be associated with a slower recovery after stroke.

Methods

This was a retrospective cohort study of adult patients hospitalized at a comprehensive stroke center with acute ischemic stroke between 1/1/2018-12/31/2019. Individual patient data was abstracted from the EHR, and zip code Gini index was obtained from the US Census Bureau. Binary logistic regression was used to assess the relationship between Gini index and functional independence (modified Rankin scale ≤2) at discharge and first outpatient follow-up. These models controlled for patient demographics, stroke risk factors, stroke severity, and stroke treatment. A second binary regression was also performed using a subset of patients to assess possible predictors of being discharged as recommended (i.e. having a discharge destination that was consistent with the recommendation of the inpatient medical team).

Results

Three hundred and thirty-seven patients were included in this analysis. The median time to first outpatient follow-up was 35 days. Zip code Gini index was not associated with functional independence at discharge but was associated with independence at follow-up (modified Rankin scale ≤2) such that patients from higher inequality neighborhoods had decreased odds of being independent. More specifically, each 1% increase in neighborhood Gini index was associated with 8% decreased odds of independence at follow-up (OR=0.923, 95% CI: 0.863-0.987). Being discharged as recommended was associated with increased odds of independence at follow-up (OR=3.359, 95% CI: 1.055-10.695). Greater income inequality (OR=0.909, 95% CI: 0.841-0.983) and Asian race (OR=0.093, 95% CI: 0.011-0.766) were associated with decreased odds of being discharged as recommended.

Conclusion

Among a cohort of patients with ischemic stroke, increased neighborhood income inequality was associated with decreased odds of achieving functional independence up (modified Rankin scale ≤2) by the time of first outpatient follow-up (at a median of 35 days following discharge). This disparity may be driven by discharge destination and race.

查看原文本刊更多论文

与缺血性中风后功能独立性相关的邻里收入不平等：一项队列研究。

背景：社会经济地位的个体测量与缺血性中风患者中风后的残疾有关。然而，社区的收入分配是否会对中风康复产生影响尚不清楚。我们假设，邻里收入不平等的加剧（以基尼指数衡量）可能与中风后恢复较慢有关：这是一项回顾性队列研究，研究对象是 2018 年 1 月 1 日至 2019 年 12 月 31 日期间在综合卒中中心住院治疗的急性缺血性卒中成年患者。患者个人数据来自电子病历，邮政编码基尼指数来自美国人口普查局。二元逻辑回归用于评估基尼指数与出院时和首次门诊随访时功能独立性（改良Rankin量表≤2）之间的关系。这些模型对患者的人口统计学特征、卒中风险因素、卒中严重程度和卒中治疗进行了控制。此外，还使用患者子集进行了第二次二元回归，以评估按建议出院（即出院目的地与住院医疗小组的建议一致）的可能预测因素：本次分析共纳入 337 名患者。首次门诊随访的中位时间为 35 天。邮政编码基尼指数与出院时的功能独立性无关，但与随访时的独立性有关（修正的兰金量表≤2），因此来自不平等程度较高的社区的患者独立的几率较低。更具体地说，社区基尼指数每增加1%，随访时独立的几率就会降低8%（OR=0.923，95% CI：0.863-0.987）。按建议出院与随访时独立的几率增加有关（OR=3.359，95% CI：1.055-10.695）。收入更不平等（OR=0.909，95% CI：0.841-0.983）和亚洲人种（OR=0.093，95% CI：0.011-0.766）与按建议出院的几率降低有关：结论：在一组缺血性脑卒中患者中，邻里收入不平等的加剧与首次门诊随访时（出院后中位数 35 天）达到功能独立（修正的 Rankin 评分≤2）的几率降低有关。这种差异可能是由出院目的地和种族造成的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.