Neighborhood Deprivation and Functional Outcomes Following Ischemic Stroke (P2-4.007)

To test the hypothesis that neighborhood deprivation leads to unfavorable long-term functional outcomes following acute ischemic stroke (AIS). The association between neighborhood deprivation and the risks of disease and mortality among ischemic stroke patients is well-documented. However, the role of neighborhood deprivation in long-term outcomes following acute brain injury remains understudied. We conducted a nested study within a prospective longitudinal study following patients with acute brain injury admitted to Connecticut's largest health system. This study focused on AIS survivors and assessed neighborhood deprivation using the Area Deprivation Index (ADI), a metric using 9-digit zip codes to rank neighborhoods based on income, employment, education, and housing quality. Patients were stratified into tertiles based on their ADI, designated as low, intermediate, or high deprivation. Functional outcomes were evaluated using the modified Rankin Scale at one-year post-stroke, dichotomized into favorable (0-2) and unfavorable (3-6) scores. Our analysis employed multivariable logistic regression for adjusted analyses. Among 2,540 AIS patients enrolled between 2018 and 2021, 1,898 patients had zip code and outcomes data (mean age 70 years, 48% female, 17% Black, 7.0% Hispanic). The one-year unadjusted risk of poor outcomes was 40.0%, 42.8%, and 49.2% for patients residing in neighborhoods with low, intermediate, and high deprivation, respectively (unadjusted p=0.001). These findings remained significant in multivariate analyses that controlled for confounding factors including comorbidities and stroke severity. Compared to patients living in neighborhoods with low deprivation, those living in areas with intermediate and high deprivation had 39% (OR 1.39, 95% CI 1.09-1.77) and 97% (OR 1.98, 95% CI 1.54-2.54) greater risk of unfavorable outcomes (test-for-trend p<0.001). Our study underscores the connection between neighborhood deprivation and an elevated risk of unfavorable outcomes. We validate the utility of the ADI as an analytical tool for evaluating neighborhood deprivation as a composite for several social determinants of health. Disclosure: Ms. Kleinberg has nothing to disclose. Mr. Clocchiatti-Tuozzo has nothing to disclose. Dr. Rivier has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pyxis Partners. Mr. Torres-Lopez has nothing to disclose. Ms. Kim has nothing to disclose. Ms. Kitlen has nothing to disclose. Mr. Kampp has nothing to disclose. Sara Jasak has nothing to disclose. Dr. Schindler has received personal compensation for serving as an employee of Aeromics. Dr. Schindler has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Aeromics. Dr. Schindler has received stock or an ownership interest from Aeromics. Dr. Schindler has received publishing royalties from a publication relating to health care. Dr. Sansing has nothing to disclose. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care. The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.