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. 2024 Sep 6;3(10):101258.
doi: 10.1016/j.jacadv.2024.101258. eCollection 2024 Oct.

Social Vulnerability Index and All-Cause Mortality After Acute Ischemic Stroke, Medicare Cohort 2020-2023

Xin Tong  1 , Susan A Carlson  1 , Elena V Kuklina  1 , Fátima Coronado  1 , Quanhe Yang  1 , Robert K Merritt  1
Affiliations

Social Vulnerability Index and All-Cause Mortality After Acute Ischemic Stroke, Medicare Cohort 2020-2023

Xin Tong et al. JACC Adv. .

Abstract

Background: Inequities in stroke outcomes have existed for decades, and the COVID-19 pandemic amplified these inequities.

Objectives: This study examined the association between social vulnerability and all-cause mortality among Medicare beneficiaries hospitalized with acute ischemic stroke (AIS) during COVID-19 pandemic periods.

Methods: We analyzed data on Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with AIS between April 1, 2020, and December 31, 2021 (followed until December 31, 2023) merged with county-level data from the 2020 Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry's Social Vulnerability Index (SVI). We used a Cox proportional hazard model to examine the association between SVI quartile and all-cause mortality.

Results: Among 176,123 Medicare fee-for-service beneficiaries with AIS, 29.9% resided in the most vulnerable counties (SVI quartile 4), while 14.9% resided in counties with least social vulnerability (SVI quartile 1). AIS Medicare beneficiaries living in the most vulnerable counties had the highest proportions of adults aged 65 to 74 years, non-Hispanic Black or Hispanic, severe stroke at admission, a history of COVID-19, and more prevalent comorbidities. Compared to those living in least vulnerable counties, AIS Medicare beneficiaries living in most vulnerable counties had significantly higher all-cause mortality (adjusted HR: 1.11, 95% CI: 1.08-1.14). The pattern of association was largely consistent in subgroup analyses by age group, sex, and race and ethnicity.

Conclusions: Higher social vulnerability levels were associated with increased all-cause mortality among AIS Medicare beneficiaries. To improve outcomes and address disparities, it may be important to focus efforts toward addressing social vulnerability.

Keywords: COVID-19; Social Vulnerability Index; acute ischemic stroke; all-cause mortality; hospitalizations.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
SVI Distribution and Adjusted HRs for All-Cause Mortality SVI = Social Vulnerability Index.
Central Illustration
Central Illustration
High Social Vulnerability Was Significantly Associated With Increased All-Cause Mortality Among Those Hospitalized With Acute Ischemic Stroke SVI = Social Vulnerability Index.
See this image and copyright information in PMC

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