Letter to the Editor on “The Impact of Body Mass Index Classification on Outcomes Following Stroke Rehabilitation: A Retrospective Study”

Abstract

W e thank Ms Ballesteros and her coauthors for their insightful comments on our article. We agree wholeheartedly on the importance of social determinants of health including education and income levels on not only the opioid epidemic but also the general health of the population in the community. The Southeastern United States has indeed been shown to be disproportionally impacted by lower education levels, higher rates of poverty, and higher rates of chronic medical comorbidities.We also agree that these areas are often underserved not only in availability of pain and addiction specialists but also in availability of general practitioners, hospitals, and pharmacies, which likely further contribute to the poor opioid related outcomes. Unfortunately, many of the social determinants of health are closely intercorrelated, which makes it very difficult to isolate and attribute poor health outcomes to individual factors. Nonetheless, there seems to be disproportionately high needs for prevention and treatment of opioid use disorder in the Appalachian region, for which we would want to see an increased availability of specialists in pain and addiction to address the problem. We certainly do not expect that increases in specialists and treatment centers alone will solve the complex and multifaceted conundrum that is the opioid epidemic in the United States. We agree that there is a need to expand medical education opportunities within vulnerable communities, and it is crucial to increase awareness for the impact of socioeconomic disparities along all current and future healthcare providers.We again would like to thank our colleagues for their interest and insight.