Abstract TMP99: Neighborhood Disadvantage And Outcomes Following Intracerebral Hemorrhage

Abstract

Introduction: Neighborhood disadvantage is associated with various health factors. Given the mounting evidence linking social determinants to risk of, and outcomes after, spontaneous intracerebral hemorrhage (ICH), we tested the hypothesis that higher neighborhood disadvantage leads to poorer outcomes following ICH. Methods: We conducted a nested study within an ongoing longitudinal study that prospectively follows patients with acute brain injury admitted to Connecticut’s largest healthcare system. The nested study included ICH survivors and evaluated neighborhood deprivation using the Area Deprivation Index, a publicly available metric that uses 9-digit zip codes to rank neighborhoods’ socioeconomic disadvantage based on factors such as income, employment, and education. Patients were given a tertile designation according to the Area Deprivation Index: low, intermediate, and high deprivation. Functional outcome was evaluated through the 6-month post-ICH Modified Rankin Scale, dichotomized as 0-3 (good outcome) and 4-6 (poor outcome). We used chi-square tests and multivariable logistic regression for unadjusted and adjusted association analyses, respectively. Results: Out of 687 ICH patients enrolled from 2018 to 2022, 518 (mean age 67, 47.5 % female, 19% Black, 8% Hispanic) had 9-digit zip code and outcomes data. The unadjusted risk of poor outcome was 40%, 55%, and 61% for patients living in neighborhoods with low, intermediate, and high disadvantage (unadjusted p=0.02). This association was confirmed in multivariable analyses adjusting for potential confounders: compared to patients living in low-disadvantage neighborhoods, those living in neighborhoods with intermediate and high disadvantage had 66% (OR 1.66, 95% CI 0.82-3.40) and 2.5 times (OR 2.44, 95% CI 1.17-5.19) higher risk of poor outcomes (test-for-trend p=0.01). Conclusion: Among ICH survivors enrolled in a prospective study of acute brain injury, increased neighborhood disadvantage was associated with a higher risk of poor outcomes. Our results validate the Area Deprivation Index as a useful tool to assess the numerous social determinants of health. Additionally, our findings highlight the negative role of these social determinants in patients' recoveries.