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Observational Study
. 2018 Aug 7;91(6):e509-e516.
doi: 10.1212/WNL.0000000000005946. Epub 2018 Jul 6.

Socioeconomic determinants of outcome after childhood arterial ischemic stroke

Lori C Jordan  1 , Nancy K Hills  2 , Christine K Fox  2 , Rebecca N Ichord  2 , Paola Pergami  2 , Gabrielle A deVeber  2 , Heather J Fullerton  2 , Warren Lo  2 ; VIPS Investigators
Collaborators, Affiliations
Observational Study

Socioeconomic determinants of outcome after childhood arterial ischemic stroke

Lori C Jordan et al. Neurology. .

Abstract

Objective: To determine whether lower socioeconomic status (SES) is associated with worse 1-year neurologic outcomes and reduced access to rehabilitation services in children with arterial ischemic stroke (AIS).

Methods: From 2010 to 2014, the Vascular effects of Infection in Pediatric Stroke (VIPS) observational study prospectively enrolled and confirmed 355 children (age 29 days-18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars) at the time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure scores were categorized as 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome.

Results: At 12 ± 3 months after stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income (<US $10,000), but not other markers of SES, was associated with worse outcomes (odds ratio [OR] 3.13, 95% confidence interval [CI] 1.43-6.88, p = 0.004). In multivariable analysis, including adjustment for stroke etiology, this association persisted (OR 3.17, 95% CI 1.18-8.47, p = 0.02). Income did not correlate with receiving rehabilitation services at 1 year after stroke; however, quality and quantity of services were not assessed.

Conclusions: In a large, multinational, prospective cohort of children with AIS, low income was associated with worse neurologic outcomes compared to higher income levels. This difference was not explained by stroke type, neurologic comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear and warrant further investigation.

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Figures

Figure 1
Figure 1. VIPS patients (n = 320) included in outcomes analyses (red-shaded boxes): 10 patients who died before discharge and 310 patients with outcomes assessments at 1 year
aAssigned Pediatric Stroke Outcome Measure (PSOM) score of 10. bFormal PSOM score directly assessed by site neurologist performing a neurologic examination. cParental PSOM score indirectly assessed by parental interview with the Pediatric Stroke Recovery and Recurrence Questionnaire. AIS = arterial ischemic stroke; VIPS = Vascular Effects of Infection in Pediatric Stroke.
Figure 2
Figure 2. Percentage of children in each outcome category according to income level
PSOM = Pediatric Stroke Outcome Measure; USD = US dollars.
See this image and copyright information in PMC

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