Abstract WP273: The Association of Social Determinants of Health on Functional Outcome After Intracerebral Hemorrhage

Abstract

Background: It remains unknown which social determinants of health (SDOH) are impactful or when disparities begin to emerge in intracerebral hemorrhage (ICH). This study aimed to investigate the association between pre-stroke SDOH and post-stroke functional outcome. Methods: Data from the Massachusetts General Hospital (MGH) ICH cohort was used and included age, sex, ICH severity, history of hypertension, tobacco use, diabetes, coronary artery disease, atrial fibrillation, liver disease, history of dementia, and history of prior ICH. SDOH exposures included income bracket, educational attainment, marital status, race, and religion. The primary outcome was the modified Rankin Score (mRS) measured at 12 months. Baseline characteristics, past medical history, and SDOH among those with mild stroke versus severe stroke were compared using the Wilcoxon Rank Sum test and chi-square tests. Factors from the univariate analysis which were associated with stroke severity (p<0.05) were included in a logistic regression model. Results: Of the 315 patients with available 12-month mRS, 180 (57%) had mRS scores <3 or relatively good functional outcomes, and 135 (43%) had mRS scores >=3 or relatively poor functional outcomes. The median age of those with low mRS was 69 compared to 76 for those with high mRS. Those with high mRS were more likely to have high school-only education or a diagnosis of dementia on admission compared to those with low mRS. Those with high school-only education were 2.94 times more likely than college diplomates to have high mRS (OR 2.94, 95% CI 1.57-5.53). Similarly, those with a diagnosis of dementia on admission, were 6.22 times more likely than those without a diagnosis of dementia to have high mRS (OR 6.22, 95% CI 1.70-22.75). Discussion: In addition to clinical determinants of age, ICH severity, and underlying dementia, educational attainment was an independent predictor of poor functional outcome after ICH. We recognize the impact of survival bias in our study design; however, we found differences in recovery despite this bias. Our findings suggest that disparities in outcomes exist even in relatively homogenous patient populations and that SDOH prior to an ICH still have associations with functional outcomes after stroke.