Abstract TMP43: Concerning Rise In Young-onset Stroke Hospitalizations And Non-improving Outcomes In Patients From Low Household Income Quartile: A National Perspective A Decade Apart (2007 Vs. 2017)

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Background: Health equity and the reduced socioeconomic gap between communities are the main objectives of healthcare delivery in the US with a shifting focus towards social determinants of health. We aimed to compare stroke hospitalizations and outcomes in young patients with low median household income (LMHI) across two national cohorts a decade apart (2007 vs. 2017). Methods: We used National Inpatient Sample (2007 & 2017) to identify young-onset stroke hospitalizations (18-44 years, YOS) belonging to LMHI (0-25th quartile) using relevant codes. Demographics, comorbidities, adjusted risk of YOS and outcomes were compared between two cohorts. Results: Of 34249 LMHI YOS admissions, 13749 belonged to 2007 and 20500 to 2017 (median age 39 vs 38 years, p<0.001). The risk of YOS was 30% higher in 2017 young LMHI admissions than in 2007 when adjusted for socio-demographics and comorbidities (aOR 1.30, 95%CI:1.27-1.34, p<0.001) (Table 1). Gender distribution was comparable for YOS between 2007 and 2017. The 2017 YOS cohort often consisted of white (38.4 vs 33.3%), non-elective admissions (94.9 vs 91.1%) and often had cardiovascular comorbidities and concomitant smoking (42.4 vs 26.9%); whereas lower rates of alcohol (5.5% vs. 8.7%) and drug abuse (12.1 vs. 16%) than in 2007 (p<0.001). Though adjusted all-cause mortality was comparable between the two cohorts (aOR 0.91, 95%CI:0.82-1.00, p=0.054) with shortened stay (5 vs. 4 days) and fewer transfers in 2017; adjusted hospital costs were higher in 2017 (p<0.001). Conclusion: There was an alarming 30% higher risk of YOS admissions in patients from the LMHI quartile across 2 national cohorts a decade apart in the US without any significant improvement in mortality odds when controlled for confounders. Our analysis indicates the need for the adoption and propagation of preventive measures and vigilance to lessen CVD and YOS risk, improve health outcomes and decrease healthcare costs among young patients from LMHI quartile.