Fakoori Farya, Zhou Lili, Gardener Hannah, Gutierrez Carolina, Asdaghi Negar, Bishop Lauri, Brown Scott C, Campo-Bustillo Iszet, Gordon Perue Gillian, Johnson Karlon H, Veledar Emir, Ying Hao, Romano Jose G, Rundek Tatjana, Marulanda Erika
University of Miami Miller School of Medicine, Miami, FL, USA.
TCSD-S Investigators detailed in Supplemental Table I.
J Stroke Cerebrovasc Dis. 2025 Apr 26;34(7):108330. doi: 10.1016/j.jstrokecerebrovasdis.2025.108330.
Poor socioeconomic conditions are linked to increased stroke-related mortality and worse clinical outcomes post-stroke. This study examines the association between neighborhood socio-demographic (NSD) profile and adequate transitions of care (ATOC) in acute ischemic stroke patients one month after discharge.
The Transitions of Care Stroke Disparities Study (TCSD-S) is an observational prospective cohort investigating disparities in stroke care transitions. Data from 1132 acute ischemic stroke (AIS) patients was obtained from three sources: 1) publicly available NSD data using participants' ZIP codes, 2) Structured telephone interviews at 30 days post-discharge to ascertain participants' behavior in six categories, and 3) covariates obtained from Get with the Guidelines-Stroke® (GWTG-S). Logistic regression models examined the relationship between NSDs and achieving ATOC, defined as adherence to at least 75 % of the six behavioral modifications for ATOC, adjusting for patient demographics, social determinants of health, and stroke severity.
The sample included 56 % males, 51.5 % non-Hispanic White, 22.6 % non-Hispanic Black, and 21.8 % Hispanic individuals, with a median age of 64 (IQR = 55-74 years). ATOC was achieved in 994 (88 %) participants. While NSDs did not independently predict the overall ATOC success, we observed a direct association of NSD profile (education level and median income) with patients' adherence to rehabilitation follow-up (p = 0.03), toxic habit cessation (p = 0.04), and medical appointment attendance (p = 0.04), independent of the effects of individual socioeconomic status.
Neighborhood socioeconomic status directly impacts protective behaviors. This finding can inform future community-level interventions aimed at improving patients' adherence to behavioral modifications.
社会经济条件较差与中风相关死亡率增加及中风后更差的临床结局有关。本研究调查出院后1个月急性缺血性中风患者的邻里社会人口统计学（NSD）概况与适当的护理过渡（ATOC）之间的关联。
护理过渡中风差异研究（TCSD-S）是一项观察性前瞻性队列研究，调查中风护理过渡中的差异。来自1132名急性缺血性中风（AIS）患者的数据从三个来源获得：1）使用参与者邮政编码的公开可用NSD数据，2）出院后30天的结构化电话访谈，以确定参与者在六个类别中的行为，3）从“遵循中风指南”（GWTG-S）获得的协变量。逻辑回归模型检查了NSD与实现ATOC之间的关系，ATOC定义为至少75%遵守ATOC的六种行为改变，同时对患者人口统计学、健康的社会决定因素和中风严重程度进行了调整。
样本包括56%的男性、51.5%的非西班牙裔白人、22.6%的非西班牙裔黑人以及21.8%的西班牙裔个体，中位年龄为64岁（四分位间距=55-74岁）。994名（88%）参与者实现了ATOC。虽然NSD不能独立预测ATOC的总体成功率，但我们观察到NSD概况（教育水平和中位收入）与患者坚持康复随访（p = 0.03）、戒烟限酒（p = 0.04）和按时就诊（p = 0.04）之间存在直接关联，独立于个体社会经济地位的影响。
邻里社会经济地位直接影响保护行为。这一发现可为未来旨在改善患者对行为改变依从性的社区层面干预提供参考。
