Neighborhood socio-demographic profile associated with adequate transitions of stroke care: The transitions of care stroke disparities study.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

Neighborhood socioeconomic status directly impacts protective behaviors. This finding can inform future community-level interventions aimed at improving patients' adherence to behavioral modifications.