Understanding the link between neighborhood socioeconomic status and stroke recovery

In a 2021 study, Eric Stulberg, MD, MPH, assistant professor of neurology at Thomas Jefferson University, found an association between lower neighborhood socioeconomic status (nSES) and worse stroke recovery outcomes. “Even after accounting for individual economic status, as measured by their education level and insurance status, those in lower socioeconomic neighborhoods tend to have worse stroke recovery outcomes than those who are in the higher socioeconomic neighborhoods,” Dr. Stulberg says.

While these results have since been replicated by other researchers, it’s still unclear what factors are behind this link. However, stroke is a leading cause of disability in the U.S., and identifying these factors could be essential for improving patient outcomes, particularly in those living in lower socioeconomic neighborhoods. “If we found something that was modifiable, it would basically give us a target to intervene upon, which hasn't been done yet,” says Dr. Stulberg.

In a new study published in JAMA Network Open, Dr. Stulberg’s team hypothesized that healthcare access and neighborhood factors like receipt of emergency treatment following a stroke, neighborhood density of home health services, density of rehabilitation clinics, density of recreation centers, transportation access, and walkability could mediate the link between nSES and stroke recovery. It is one of the first studies to rigorously test the impact of modifiable factors on this link.

To test this, they analyzed data on stroke recovery outcomes, including functional status, quality of life, and depressive symptoms, in a cohort of 2,203 stroke patients in Corpus Christi, Texas, for 90 days post-stroke. Patient nSES was defined based on the census tracts they lived in at the time of their stroke.

While results showed some indication that density of home health services and rehabilitation clinics may mediate some of the association between nSES and stroke recovery, these findings were not statistically significant. No other factors were identified as potential mediators of this link.

Because of this, Dr. Stulberg says, future research should look at other potential mediators like the type of care setting patients are discharged to, time to emergency treatment, and the total amount of therapy patients receive. “I hope that other people will adopt our methodological framework going forward to better understand this link,” says Dr. Stulberg.

By Zoe Cunniffe