Regional Disparities in the Social Determinants of Stroke Severity

Abstract

Introduction: Social determinants of health (SDOH) are known factors of stroke risk and outcomes. We aim to gain a comprehensive understanding of the impact of stroke risk-specific SDOH on stroke severity by investigating the patient population served by a regional healthcare system.

Methods: This retrospective cohort study analyzed patient data from the American Heart Association's Get With The Guidelines-Stroke (AHA GWTG-S) Case Record Forms, collected from three stroke centers between January 2022 and May 2024. We compared the patient ordinal modified Rankin Scale (mRS) and the National Institutes of Health Stroke Scale (NIHSS) scores to the predictor variables of age, sex, race, Hispanic ethnicity, ZIP code, payment sources, and mode of arrival.

Results: When age-adjusted, Black or African American patients had higher mean NIHSS scores and higher rates of Minor Stroke Symptoms than White patients (p<0.01, p<0.01). ZIP Codes with higher mean NIHSS stroke scale scores correlated significantly with ZIP Codes defined by lower median household income (r=-0.61, p<0.01), lower education attainment (r=-0.71, p<0.001), and higher percentages of minority group populations (r=0.50, p<0.02). Patients with higher mean scores across all measures were those associated with using Medicare versus private insurance (p<0.0001) and those arriving at the hospital via EMS versus private transport (p<0.01).

Conclusions: This research addresses the significance of surveying region-specific social determinants of health for insight into targeted interventions. Initiatives such as expanding stroke awareness education and increasing preventative screenings in the community may reduce disparities in stroke severity and improve outcomes in underserved areas.