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. 2021 Oct 11;97(15):e1503-e1511.
doi: 10.1212/WNL.0000000000012676.

Association of Neighborhood-Level Material Deprivation With Health Care Costs and Outcome After Stroke

Amy Y X Yu  1 , Eric E Smith  2 , Murray Krahn  2 , Peter C Austin  2 , Mohammed Rashid  2 , Jiming Fang  2 , Joan Porter  2 , Manav V Vyas  2 , Susan E Bronskill  2 , Richard H Swartz  2 , Moira K Kapral  2
Affiliations

Association of Neighborhood-Level Material Deprivation With Health Care Costs and Outcome After Stroke

Amy Y X Yu et al. Neurology. .

Abstract

Background and objectives: To determine the association between material deprivation and direct health care costs and clinical outcomes following stroke in the context of a publicly funded universal health care system.

Methods: In this population-based cohort study of patients with ischemic and hemorrhagic stroke admitted to the hospital between 2008 and 2017 in Ontario, Canada, we used linked administrative data to identify the cohort, predictor variables, and outcomes. The exposure was a 5-level neighborhood material deprivation index. The primary outcome was direct health care costs incurred by the public payer in the first year. Secondary outcomes were death and admission to long-term care.

Results: Among 90,289 patients with stroke, the mean (SD) per-person costs increased with increasing material deprivation, from $50,602 ($55,582) in the least deprived quintile to $56,292 ($59,721) in the most deprived quintile (unadjusted relative cost ratio and 95% confidence interval 1.11 [1.08, 1.13] and adjusted relative cost ratio 1.07 [1.05, 1.10] for least compared to most deprived quintile). People in the most deprived quintile had higher mortality within 1 year compared to the least deprived quintile (adjusted hazard ratio [HR] 1.07 [1.03, 1.12]) as well as within 3 years (adjusted HR 1.09 [1.05, 1.13]). Admission to long-term care increased incrementally with material deprivation and those in the most deprived quintile had an adjusted HR of 1.33 (1.24, 1.43) compared to those in the least deprived quintile.

Discussion: Material deprivation is a risk factor for increased costs and poor outcomes after stroke. Interventions targeting health inequities due to social determinants of health are needed.

Classification of evidence: This study provides Class II evidence that the neighborhood-level material deprivation predicts direct health care costs.

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Figures

Figure 1
Figure 1. Mean Direct Health Care Costs by Health Care Setting and by Neighborhood-Level Deprivation Quintile
Figure 2
Figure 2. Hazard Ratios (95% Confidence Intervals) Comparing Each Material Deprivation Quintile to the Least Deprived Group (Quintile 1) Using Cox Proportional Hazard Models for Death and Cause-Specific Hazard Models for Long-term Care Admission
aModel not adjusted for covariates. bModel adjusted for age and sex only. cModel adjusted for age, sex, rural home location, hypertension, diabetes, atrial fibrillation, dyslipidemia, coronary artery disease, peripheral arterial disease, prior history of stroke, stroke type, and stroke severity.
Figure 3
Figure 3. Cumulative Incidence of Admission to Long-term Care (LTC) in the First Year after Stroke for Each Deprivation Group
Shaded area represents 95% confidence bands. Deprivation quintile 1 is least deprived and 5 is most deprived.
See this image and copyright information in PMC

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