Abstract T MP70: Dense Households and Weak Social Networks Increase Risk of Recurrent Vascular Events

Abstract

Background: Social isolation is associated with increased vascular events post stroke, but the role of living arrangements versus social networks on stroke outcomes has not been well explored. We aim to characterize these associations overall and by race-ethnicity. Methods: The Stroke Warning Information and Faster Treatment (SWIFT) study tested a stroke preparedness intervention on arrival times for stroke/TIA recurrence to the ED. Stroke/TIA patients able to consent were prospectively recruited and randomized. Baseline data collection included demographics, medical history, socioeconomic status (SES), and social support networks. Living arrangements were categorized as living alone, living with one or 2 people, or living with three or more people (dense household). Weak social support networks defined as 4 or less family or friend visits in past week. Participants were followed for a mean of 2.9 years. An outcome of vascular event was defined as stroke, TIA, MI, or death post enrollment. Multivariate logistic regression models examined the relationship between vascular outcomes, living arrangements and social support networks adjusting for demographics, health and SES. Results: Between 2005 and 2009 1193 participants were enrolled: mean age 63 years; 51% Hispanics, 26% whites, and 17% Blacks; 50% female; and 42% < high school education. Over 24% lived alone, 23% lived with spouse/partner only, and 21% lived in dense households. In adjusted logistic models, post stroke vascular events were associated with dense households [RR 1.5 (95% CI: 1.1 - 1.9)], and weak family networks [RR 1.9 (95% CI: 1.4 - 2.8)]. Stratifying by race-ethnicity, the results remained significant for Hispanics where dense households [RR 1.9 (95% CI: 1.3 - 2.6)], weak family networks [RR 2.8 (95% CI: 1.5 - 5.1)], and weak friend networks [RR 1.5 (95% CI: 1.0 - 2.5)] increased vascular events post stroke. Conclusion: Living in dense households can increase risk of vascular events post stroke, while stronger social support networks can decrease this risk especially among Hispanic stroke survivors. Future research is needed to explore the mechanism of these associations and to identify possible racial/ethnic tailored interventions based on living arrangements and social networks.