Stroke Severity Mediates the Association Between Socioeconomic Disadvantage and Poor Outcomes Among Patients With Acute Ischemic Stroke

Background Impact of mediating factors on the relationship between socioeconomic disadvantage and outcomes among patients with acute ischemic stroke has not been well characterized. Methods Data were extracted from electronic medical records, 90‐day modified Rankin scale (mRS) scores collected as part a prospective registry. Exact patient addresses geocoded characterized using Area Deprivation Index (ADI) ranks. The ≥3 categorized poor outcomes. Logistic regression models (adjusted for treatment intravenous tissue plasminogen activator or intraarterial therapy, sociodemographics, comorbidities) fitted to compute adjusted odds ratios (aORs) 95% CIs total effect high ADI In‐hospital mortality (versus survived) unfavorable favorable) discharge disposition also evaluated Structural equation modeling was used report average causal mediation effects severity (National Institutes Health Stroke Scale [NIHSS]) (intravenous therapy). Results Between May 2016 December 2021, 13 641 (median age, 69 years; 50.1% women) included. Among 3002 functional data, significantly associated score (aOR, 1.16 [95% CI, 1.04–1.29]). Patients in higher neighborhoods had increased having NIHSS 1.19 1.07–1.32]). Likewise, 9.34 7.64–11.5]). neighborhood 59% mediated by (average effects: P <0.001). accounted 93% pathway discharges. ADI, did mediate any Conclusions Neighborhood leads hospital discharges worse disability, via severity. Tracking social determinants health may identify opportunities reducing onset severe strokes