Socioeconomic influences on stroke outcomes: A comprehensive zip code-based hospital analysis

Abstract

Background and objectives

Stroke remains a leading cause of morbidity and mortality worldwide. Socioeconomic disparities significantly affect the treatment and outcomes of cardiovascular and cerebrovascular diseases, including acute ischemic stroke. This study examines patients treated at Thomas Jefferson University Hospital, with ZIP code-based socioeconomic data predominantly representing areas in Pennsylvania and New Jersey, as the majority of patients originate from these regions.

Methods

This study is a retrospective analysis based on a prospectively maintained database of 697 patients who underwent mechanical thrombectomy between 2016 and 2023. ZIP codes were retrospectively added to the database to determine socioeconomic status (SES). SES was assessed by matching patient ZIP codes to median household income data from the Census for the years 2016–2022. Baseline characteristics, stroke characteristics, procedural details, and outcomes were collected. Patients were stratified into income quintiles (Q1: $14,658–$52,635; Q2: $52,905–$64,046; Q3: $64,140–$77,737; Q4: $78,449–$95,128; Q5: $95,231–$217,674). Multivariate regression was conducted to identify predictors of good functional outcomes (mRS 0–2).

Results

The study included 697 patients representing 270 zip codes distributed across income quintiles as follows: Q1 (n = 140), Q2 (n = 142), Q3 (n = 138), Q4 (n = 138), and Q5 (n = 139). Significant racial differences were observed between income quintiles, with a higher proportion of African-American patients in Q1 (40.7 %) compared to Q5 (19.9 %; p < 0.001), and more white patients in Q5 (82.7 %) compared to Q1 (47.1 %; p < 0.001). The Onset to arterial puncture time was longer in Q1 (369 min) compared to Q5 (258 min; p = 0.004). There were no significant differences in stroke outcomes such as successful recanalization (TICI 2b-3), hemorrhagic transformation, median NIHSS score on discharge, 30-day readmission, disposition to home, or length of stay between Q1 and Q5. SES was not a significant predictor of good functional outcomes (mRS 0–2).

Conclusion

This study found no significant differences in stroke outcomes between low SES and high SES patients undergoing mechanical thrombectomy for acute ischemic stroke. Patients from higher SES had a shorter duration from stroke onset to arterial puncture, and there was a tendency though not significant for higher SES patients to have a higher rate of 30-day readmission, and higher rate of discharge to home. Further research is needed to confirm.