Abstract WMP106: The Impact of Social Determinants of Health on Ambulatory Status at Discharge Following Acute Ischemic Stroke: Findings From the Get With the Guidelines-Stroke Registry

Abstract

Background: Medical comorbidities and stroke risk factors only explain a proportion of stroke incidence and outcomes in different populations. Social determinants of health(SDOH)have been associated with incident stroke. The objective of our analysis was to determine if SDOH are associated with ambulatory status at discharge following acute ischemic stroke(IS) hospitalization. Methods: We included IS patients hospitalized from January 1, 2015-December 31, 2019 who were ambulating at baseline and had known county of residence in the GWTG registry. The primary outcome measure was ambulatory status at discharge, defined as ability to ambulate with or without the assistance of a device or person. Estimates of SDOH including education status, income, employment status, poverty and foreign-born residents at patients’ residence county were the main predictors. Baseline demographics, clinical comorbidities, stroke center certification status among other logistic and event-related factors were analyzed. Covariates included demographic, clinical factors and hospital-related factors. Estimates of county level SDOH were classified into quartiles and the relative odds of outcome were assessed using a multivariable logistic regression. Results: Of 1,171,519 observations included in our final analysis, median age was 71 years, 49% were female, 78% were of white ethnicity and 45% were insured through Medicaid/Medicare. In multivariable logistic regression analysis adjusting for baseline characteristics, counties with the lowest quartile education level had a lower likelihood of being ambulatory at discharge than the highest quartile (OR0.91[95%CI 0.86-0.96],p=0.001).Patients from counties with the lowest quartile of foreign-born residents were more likely to be ambulatory at discharge than the highest quartile (OR1.11[95%CI 1.05-1.18];P=0.001). Income, employment status, and poverty were not associated with ambulatory status at discharge. Conclusion: County level SDOH including education and percentage of foreign born population were associated with ambulatory status at discharge after ischemic stroke hospitalization. Our findings can be used to develop interventions that reduce inequity in ischemic stroke outcomes at discharge.