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Multicenter Study
. 2023 May;32(5):107059.
doi: 10.1016/j.jstrokecerebrovasdis.2023.107059. Epub 2023 Feb 20.

Household income is associated with functional outcomes in a multi-institutional cohort of patients with ischemic stroke and COVID-19

Brian Stamm  1 , Regina Royan  2 , Gabriela Trifan  3 , Ronald Alvarado-Dyer  4 , Faddi G Saleh Velez  5 , William Taylor  6 , Pranusha Pinna  7 , Nicholas J Reish  8 , Alejandro Vargas  9 , Fernando D Goldenberg  4 , Michael J Schneck  10 , José Biller  10 , Fernando Testai  3 , Fan Z Caprio  8 , Sherry H Chou  8 , Philip B Gorelick  8 , Eric M Liotta  8 , Ayush Batra  11
Affiliations
Multicenter Study

Household income is associated with functional outcomes in a multi-institutional cohort of patients with ischemic stroke and COVID-19

Brian Stamm et al. J Stroke Cerebrovasc Dis. 2023 May.

Abstract

Objectives: The COVID-19 pandemic has heightened awareness of health disparities associated with socioeconomic status (SES) across the United States. We examined whether household income is associated with functional outcomes after stroke and COVID-19.

Materials and methods: This was a multi-institutional, retrospective cohort study of consecutively hospitalized patients with SARS-CoV-2 and radiographically confirmed stroke presenting from March through November 2020 to any of five comprehensive stroke centers in metropolitan Chicago, Illinois, USA. Zip-code-derived household income was dichotomized at the Chicago median. Logistic regression was used to examine the relationship between household income and good functional outcome (modified Rankin Scale 0-3 at discharge, after ischemic stroke).

Results: Across five hospitals, 159 patients were included. Black patients comprised 48.1%, White patients 38.6%, and Hispanic patients 27.7%. Median household income was $46,938 [IQR: $32,460-63,219]. Ischemic stroke occurred in 115 (72.3%) patients (median NIHSS 7, IQR: 0.5-18.5) and hemorrhagic stroke in 37 (23.7%). When controlling for age, sex, severe COVID-19, and NIHSS, patients with ischemic stroke and household income above the Chicago median were more likely to have a good functional outcome at discharge (OR 7.53, 95% CI 1.61 - 45.73; P=0.016). Race/ethnicity were not included in final adjusted models given collinearity with income.

Conclusions: In this multi-institutional study of hospitalized patients with stroke, those residing in higher SES zip codes were more likely to have better functional outcomes, despite controlling for stroke severity and COVID-19 severity. This suggests that area-based SES factors may play a role in outcomes from stroke and COVID-19.

Keywords: COVID-19; Hemorrhagic stroke; Income; Ischemic stroke; SARS-CoV-2; Stroke.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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