Pai Akshat M, To Teresa, deVeber Gabrielle A, Nichol Daniel, Kassner Andrea, Ertl-Wagner Birgit, Rafay Mubeen F, Dlamini Nomazulu
Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada.
Child Health Evaluative Sciences Program, Research Institute (A.M.P., T.T., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada.
Stroke. 2024 May;55(5):1299-1307. doi: 10.1161/STROKEAHA.123.045411. Epub 2024 Mar 15.
Time from stroke onset to hospital arrival determines treatment and impacts outcome. Structural, socioeconomic, and environmental factors are associated with health inequity and onset-to-arrival in adult stroke. We aimed to assess the association between health inequity and onset-to-arrival in a pediatric comprehensive stroke center.
A retrospective observational study was conducted on a consecutive cohort of children (>28 days-18 years) diagnosed with acute arterial ischemic stroke (AIS) between 2004 and 2019. Neighborhood-level material deprivation was derived from residential postal codes and used as a proxy measure for health inequity. Patients were stratified by level of neighborhood-level material deprivation, and onset-to-arrival was categorized into 3 groups: <6, 6 to 24, and >24 hours. Association between neighborhood-level material deprivation and onset-to-arrival was assessed in multivariable ordinal logistic regression analyses adjusting for sociodemographic and clinical factors.
Two hundred and twenty-nine children were included (61% male; median age [interquartile range] at stroke diagnosis 5.8-years [1.1-11.3]). Over the 16-year study period, there was an increase in proportion of children diagnosed with AIS living in the most deprived neighborhoods and arriving at the emergency room within 6 hours (=0.01). Among Asian patients, a higher proportion lived in the most deprived neighborhoods (=0.02) and level of material deprivation was associated with AIS risk factors (=0.001).
Our study suggests an increase in pediatric stroke in deprived neighborhoods and certain communities, and earlier arrival times to the emergency room over time. However, whether these changes are due to an increase in incidence of childhood AIS or increased awareness and diagnosis is yet to be determined. The association between AIS risk factors and material deprivation highlights the intersectionality of clinical factors and social determinants of health. Finally, whether material deprivation impacts onset-to-arrival is likely complex and requires further examination.
从中风发作到入院的时间决定治疗方式并影响预后。结构、社会经济和环境因素与成人中风的健康不平等及发作至入院时间相关。我们旨在评估儿科综合中风中心健康不平等与发作至入院时间之间的关联。
对2004年至2019年间连续入选的诊断为急性动脉缺血性中风（AIS）的儿童队列（年龄>28天至18岁）进行回顾性观察研究。社区层面的物质匮乏程度根据居住邮政编码得出，并用作健康不平等的替代指标。患者按社区层面物质匮乏程度分层，发作至入院时间分为三组：<6小时、6至24小时和>24小时。在多变量有序逻辑回归分析中评估社区层面物质匮乏程度与发作至入院时间之间的关联，并对社会人口学和临床因素进行校正。
纳入229名儿童（61%为男性；中风诊断时的中位年龄[四分位间距]为5.8岁[1.1 - 11.3]）。在16年的研究期间，居住在最贫困社区且在6小时内到达急诊室的AIS诊断儿童比例有所增加（=0.01）。在亚洲患者中，更高比例居住在最贫困社区（=0.02），且物质匮乏程度与AIS危险因素相关（=0.001）。
我们的研究表明贫困社区和某些群体中儿科中风有所增加，且随着时间推移到达急诊室的时间更早。然而，这些变化是由于儿童AIS发病率增加还是意识及诊断的提高尚待确定。AIS危险因素与物质匮乏之间的关联凸显了临床因素与健康社会决定因素的交叉性。最后，物质匮乏是否影响发作至入院时间可能很复杂，需要进一步研究。
