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. 2025 Jul;105(1):e213615.
doi: 10.1212/WNL.0000000000213615. Epub 2025 Jun 13.

Neighborhood Socioeconomic Status and the Functional Outcome of Patients Treated With Endovascular Thrombectomy for Ischemic Stroke

Bridget A Schoon  1   2 , Daniël Hansen  1 , Bob Roozenbeek  1 , Joost Oude Groeniger  3 , Wouter van der Steen  1 , Aad van der Lugt  2 , Manon Kappelhof  4   5 , Yvo B W E M Roos  6 , Charles B L M Majoie  4 , Frank van Lenthe  3 , Diederik W J Dippel  1 ; MR CLEAN-MED and MR CLEAN-NO IV investigators
Collaborators, Affiliations

Neighborhood Socioeconomic Status and the Functional Outcome of Patients Treated With Endovascular Thrombectomy for Ischemic Stroke

Bridget A Schoon et al. Neurology. 2025 Jul.

Abstract

Background and objectives: Socioeconomically deprived neighborhoods are known to have higher incidence rates of stroke and less access to high-quality stroke care. We aimed to examine whether there is an association between neighborhood socioeconomic status (nSES) and functional outcome after endovascular thrombectomy (EVT) for ischemic stroke in a high-income country.

Methods: Data from 2 randomized trials, which included patients treated with EVT within 6 hours after stroke onset: MR CLEAN-MED and MR CLEAN-NO IV were studied. A per postcode composite score of education, employment, and household income (scores ranging from -1 to 1) created by Statistics Netherlands, represented nSES. The association with functional outcome after 90 days (modified Rankin Scale [mRS]), functional independence (mRS 0-2), neurologic deficit at 24 hours (NIH Stroke Scale [NIHSS]), and radiologic outcomes (expanded treatment in cerebral infarction score and follow-up infarct volume [FIV]) were analyzed using regression analyses adjusted for patient characteristics, including baseline NIHSS.

Results: We included 910 patients (median age 71.5 years, 404 (44.4%) women, median baseline NIHSS 15) in the analyses. Patients with a higher nSES had a higher likelihood of a more favorable functional outcome (a shift toward improved outcome on the mRS) (adjusted common odds ratio [OR] 1.90, 95% CI 1.21-3.01) and were more likely to have regained functional independence (adjusted OR 3.21, 95% CI 1.82-5.70) at 90 days. There was no significant association between the nSES and the degree of neurologic deficit at 24 hours (adjusted β -0.24, 95% CI -0.50 to 0.01, p = 0.06) or radiologic outcomes (reperfusion status [adjusted OR 0.89, 95% CI 0.45-1.78], FIV [adjusted β 0.01, 95% CI -0.17 to 0.20, p = 0.89]).

Discussion: Living in a more socioeconomically affluent neighborhood was associated with a more favorable functional outcome at 90 days, but not with degree of neurologic deficit at 24 hours or radiologic outcomes. This suggests that nSES-based inequalities exist in the postacute phase of stroke care, and highlights the importance of continuing to work toward health equity for patients with stroke.

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Conflict of interest statement

A. van der Lugt reports funding from Medtronic, Cerenovus, the Dutch Heart Foundation, Brain Foundation Netherlands, the Netherlands Organization for Health Research and Development, Stryker, Penumbra, Boehringer, Trombolytic Science LLC, Health Holland Top Sector Life Sciences and Health, GE Healthcare, Siemens Healthineers, and Phillips Healthcare, all paid to institution. C.B.L.M. Majoie reports funding from Dutch Heart Foundation, Stryker, European Commission, Boehringher-Ingelheim, and Healthcare Evaluation Netherlands, all paid to institution; and is a minor shareholder of Nicolab. Y.B.W.E.M. Roos is a minor shareholder of Nicolab. D.W.J. Dippel reports unrestricted grants for research from Stryker, Medtronic, Cerenovus, Penumbra, and Trombolytic Science, all paid to institution. All other authors report no conflicting interests. Go to Neurology.org/N for full disclosures.

Figures

Figure 1
Figure 1. Study Profile
mRS = modified Rankin Scale; nSES = neighborhood socioeconomic status.
Figure 2
Figure 2. Distribution of the mRS Score at 90 Days per nSES Category
mRS = modified Rankin Scale; nSES = neighborhood socioeconomic status.
See this image and copyright information in PMC

References

    1. Buus SMØ, Schmitz ML, Cordsen P, Johnsen SP, Andersen G, Simonsen CZ. Socioeconomic inequalities in reperfusion therapy for acute ischemic stroke. Stroke. 2022;53(7):2307-2316. doi: 10.1161/STROKEAHA.121.037687 - DOI - PubMed
    1. Fukuda H, Ueba Y, Fukui N, et al. Regional disparities in prehospital delay, tPA, and mechanical thrombectomy of acute ischemic stroke with special reference to areal socioeconomic status. Interv Neuroradiol. 2022;28(1):198-199.
    1. Forman R, Okumu R, Mageid R, et al. Association of neighborhood-level socioeconomic factors with delay to hospital arrival in patients with acute stroke. Neurology. 2024;102(1):e207764. doi: 10.1212/WNL.0000000000207764 - DOI - PMC - PubMed
    1. Buus SM, Schmitz ML, Cordsen P, Paaske Johnsen S, Andersen G, Simonsen C. Socioeconomic inequalities in functional outcome after reperfusion treated ischemic stroke. Eur Stroke J. 2021;6(1 suppl):407. - PubMed
    1. Kapral MK, Fang J, Chan C, et al. Neighborhood income and stroke care and outcomes. Neurology. 2012;79(12):1200-1207. doi: 10.1212/WNL.0b013e31826aac9b - DOI - PMC - PubMed