Abstract WMP51: Patient-Related Factors and Social Determinants of Health Associated With Discharge to Home Following Acute Ischemic Stroke: Findings From the Get With the Guidelines Stroke Registry

Abstract

Background: Medical comorbidities and stroke risk factors explain only a proportion of stroke incidence and outcomes in different populations. Our analysis aimed to determine if social determinants of health (SDOH) are associated with discharge home following acute ischemic stroke (AIS) hospitalization. Methods: The analyses included AIS patients hospitalized from January 1, 2015 to December 31, 2019 who were ambulating at baseline and had a known county of residence in the GWTG stroke registry. The primary outcome measure was discharge to home. County-level SDOH included income, education, owner-occupied home, unemployment, foreign-born, and insurance coverage and were the main predictors. 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 analysis, median age was 71 years, 49% were female and 78% were of white race. As shown in the Table, demographic factors associated with lower likelihood of discharge home after AIS hospitalization included being female, black race, and age >80 years. County-level SDOH factors associated with increased likelihood of discharge home included education (lowest vs highest quartile), owner occupied home (lowest vs highest quartile), foreign-born (lowest vs highest quartile), self-pay/no insurance (vs Medicare). Income (lowest vs highest quartile) and unemployment (lowest vs highest quartile) were associated with lower likelihood of discharge home. Conclusion: County-level SDOH are associated with discharge to home after AIS. Our findings can be used to develop interventions that reduce inequity in AIS outcomes.