Neighborhood Socioeconomic Status and the Functional Outcome of Patients Treated With Endovascular Thrombectomy for Ischemic Stroke.

Abstract

Socioeconomically deprived neighborhoods are known to have higher incidence rates of stroke and less access to high-quality stroke care. We aimed to examine whether there is an association between neighborhood socioeconomic status (nSES) and functional outcome after endovascular thrombectomy (EVT) for ischemic stroke in a high-income country. Data from 2 randomized trials, which included patients treated with EVT within 6 hours after stroke onset: MR CLEAN-MED and MR CLEAN-NO IV were studied. A per postcode composite score of education, employment, and household income (scores ranging from -1 to 1) created by Statistics Netherlands, represented nSES. The association with functional outcome after 90 days (modified Rankin Scale [mRS]), functional independence (mRS 0-2), neurologic deficit at 24 hours (NIH Stroke Scale [NIHSS]), and radiologic outcomes (expanded treatment in cerebral infarction score and follow-up infarct volume [FIV]) were analyzed using regression analyses adjusted for patient characteristics, including baseline NIHSS. We included 910 patients (median age 71.5 years, 404 (44.4%) women, median baseline NIHSS 15) in the analyses. Patients with a higher nSES had a higher likelihood of a more favorable functional outcome (a shift toward improved outcome on the mRS) (adjusted common odds ratio [OR] 1.90, 95% CI 1.21-3.01) and were more likely to have regained functional independence (adjusted OR 3.21, 95% CI 1.82-5.70) at 90 days. There was no significant association between the nSES and the degree of neurologic deficit at 24 hours (adjusted β -0.24, 95% CI -0.50 to 0.01, <i>p</i> = 0.06) or radiologic outcomes (reperfusion status [adjusted OR 0.89, 95% CI 0.45-1.78], FIV [adjusted β 0.01, 95% CI -0.17 to 0.20, <i>p</i> = 0.89]). Living in a more socioeconomically affluent neighborhood was associated with a more favorable functional outcome at 90 days, but not with degree of neurologic deficit at 24 hours or radiologic outcomes. This suggests that nSES-based inequalities exist in the postacute phase of stroke care, and highlights the importance of continuing to work toward health equity for patients with stroke.