Abstract WP112: Neighborhood Level Characteristics Associated With Adequate Transition of Stroke Care: The Transition of Care Stroke Disparities Study

Abstract

Objective: Transition of Care Stroke Disparities Study is an observational prospective cohort aimed to investigate disparities in the transition of stroke care (TOSC) post-hospitalization to home and to identify factors associated with adequate TOSC and stroke outcomes. we have demonstrated that higher individual socioeconomic status is associated with adequate TOSC. The present study explores the association between neighborhood-level characteristics (NLC) and adequate TOSC in ischemic stroke patients 1 month after discharge. Methods: Data from 925 ischemic stroke patients discharged from 10 Comprehensive Stroke Centers (CSCs) was obtained from three sources: a. NLC: demographic composition, level of education, and median household income from publicly available data using participants’ Zip codes (independent variables); b. 30-day post-discharge data for 6 categories of TOSC-related behaviors (dependent variables) including medication adherence, weekly exercise, medical follow-up, rehabilitation attendance, toxic habit cessation, diet modification. c. Clinical characteristics from Get with the Guidelines-Stroke (covariates). The primary outcome was 100% adequate transition of care (ATOC), a combined index of ideal adherence to all applicable behavior modifications. Results: The sample included 46% Women, 23% Non-Hispanic Black and 22% Hispanic, the average age was 64 years. NLC ranged as follows: % Black (0-93.9, median 9.1), %Hispanic (3-99.9, median 82.3), % bachelor’s degree (6.3-77.3, median 26.2), and median household income ($18,920-159,914, median $48,816). Almost a third (34%) of participants achieved 100% ATOC. In the adjusted analysis of NLC variables, higher %Hispanic (OR=1.45, 95% CI=1.03-2.04), higher %bachelor's degree recipients (OR=1.62, 95% CI=1.21-2.18), and higher median income (OR=1.12, 95%CI=1.04-1.21) were significantly associated with achieving 100% ATOC. Conclusions: Results suggest that NLC plays a crucial role in adherence to care transition instructions, underscoring the importance of interventions targeted at lower socioeconomic status populations. Future work will determine the impacts of NLC on stroke recurrence and readmission.