Neighborhood socioeconomic disadvantage and mortality after stroke

Brown, Arleen F.; Liang, Li; Vassar, Stefanie D.; Merkin, Sharon Stein; Longstreth, W. T.; Ovbiagele, Bruce; Yan, Tianhong; Escarce, José J.

doi:10.1212/wnl.0b013e31828154ae

Cited by 83 publications

(87 citation statements)

References 32 publications

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“…[6][7][8] The possible mechanisms of SED increasing mortality could be through poorer quality of healthcare provision, apart from patient's higher risk-factor prevalence and severity of stroke. 11,30 The current study showed that patients with SED received poorer quality of some aspects of acute and secondary preventive care of stroke.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Status and the Quality of Acute Stroke Care

Pan

Chen

et al. 2016

Stroke

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Background and Purpose—The association of socioeconomic status (SES) with quality of stroke care is not well understood, and few studies have examined the association with different indicators of SES simultaneously. We assessed the impacts of low levels of education, occupation, and income on the quality of stroke care.\ud \ud Methods—We examined data from the China National Stroke Registry recording consecutive stroke patients between September 2007 and August 2008. Baseline low SES was measured using educational level <6 years, occupation as manual workers or no job, and average family income per capita at ≤¥1000 per month. Compliance with 11 performances was summarized in a composite score defined as the proportion of all needed care given. Poor quality of care was defined as having a composite score of 0.71 or less.\ud \ud Results—Among 12 270 patients with ischemic stroke, 38.6% had <6 educational years, 37.6% had manual workers/no job, and 34.7% had income ≤¥1000 per month. There was an increased chance of receiving poor quality of care in patients with low education (adjusted odds ratio 1.15, 95% confidence interval 1.03–1.28), low occupation (adjusted odds ratio 1.16, 95% confidence interval 1.01–1.32), and low income (adjusted odds ratio 1.18, 95% confidence interval 1.06–1.30), respectively. People with low SES had poor performances on some aspects of care quality. Combined effects existed among these SES indicators; those with low SES from all 3 indicators had the poorest quality of care.\ud \ud Conclusions—There was a social gradient in the quality of stroke care. Continuous efforts of socioeconomic improvement will increase the quality of acute stroke care

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Section: Discussionmentioning

confidence: 99%

Socioeconomic Status and the Quality of Acute Stroke Care

Pan

Chen

et al. 2016

Stroke

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“…The differences in neighborhood SES have been consistently associated with variations in morbidity and mortality related to cardiovascular and cerebrovascular disease. 7,9,[23][24][25] Individuals residing in neighborhoods with a lower SES have a higher prevalence of comorbidities such as hypertension, diabetes, obesity and smoking, which might account for increased mortality among patients from a lower neighborhood SES. However, the differences in these comorbidities are unlikely to be the sole explanation for differences in clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,[11][12][13][14][15][16] Although these neighborhood effects are poorly understood, they may in part be mediated or moderated by individual socioeconomic, behavioral or biologic risk factors. 7 Other cultural, clinical, economic, geographic and access-related variables may also influence the timeliness of presentation for first medical assessment. While these variables are difficult to individually quantify, SES measured by zip code could serve as a useful surrogate for these intangibles.…”

Section: Introductionmentioning

confidence: 99%

Residential zip code influences outcomes following hospitalization for acute pulmonary embolism in the United States

2015

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Socioeconomic status (SES) as reflected by residential zip code may adversely influence outcomes for patients with acute pulmonary embolism (PE). We sought to analyze the impact of neighborhood SES on in-hospital mortality, use of thrombolysis, implantation of inferior vena cava (IVC) filters and cost of hospitalization following acute PE. We used the 2003-2011 Nationwide Inpatient Sample (NIS) for this analysis. All hospital admissions with a principal diagnosis of acute PE were identified using ICD-9 codes. Neighborhood SES was assessed using median household income of the residential zip code for each patient. Over this 9-year period, 276,484 discharges with acute PE were analyzed. There was a progressive decrease in in-hospital mortality across the SES quartiles (p-trend <0.001). The incidence of in-hospital mortality across quartiles 1-4 was 3.8%, 3.3%, 3.2%, and 3.1%, respectively. Despite low rates of thrombolytic utilization in this cohort, we observed a progressive increase in the rate of thrombolysis utilization across the SES quartiles (1.5%, 1.6%, 1.7%, 2.0%; p-trend <0.001). There was no significant difference in the use of IVC filters across the SES quartiles (p-trend=0.9). The mean adjusted cost of hospitalization among quartiles 2, 3, and 4, as compared to quartile 1, was significantly higher by $1202, $1650, and $1844, respectively (p-trend<0.001). In conclusion, patients residing in zip codes with lower SES had increased in-hospital mortality and decreased utilization of thrombolysis following acute PE compared to patients residing in higher SES zip codes. The cost of hospitalization for patients from higher SES quartiles was significantly higher than those from lower quartiles.

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“…[1][2][3][4][5] Residence in low-income, underresourced communities is also associated with poorer chronic disease outcomes. 1,2,[6][7][8][9][10] At the individual and the community levels, many shared mechanisms may contribute to health inequities, among them lower educational attainment and income, higher rates of deleterious health behaviors, poorer access to health care and health-promoting resources, lower quality of care, and chronic stressors. [11][12][13][14] There is limited understanding, however, of the best strategies for improving individual health outcomes and reducing health disparities in communities where physical and social conditions undermine efforts to prevent and manage chronic conditions.…”

Section: Introductionmentioning

confidence: 99%

The Healthy Community Neighborhood Initiative: Rationale and Design

Brown

Morris²,

Kahn

et al. 2016

Ethn Dis

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Objective: To describe the design and rationale of the Healthy Community Neighborhood Initiative (HCNI), a multicomponent study to understand and document health risk and resources in a low-income and minority community.Design: A community-partnered participatory research project. Setting: A low-income, biethnic African American and Latino neighborhood in South Los Angeles.Participants: Adult community residents aged >18 years.Main Outcome Measures: Household survey and clinical data collection; neighborhood characteristics; neighborhood observations; and community resources asset mapping.Results: We enrolled 206 participants (90% of those eligible), of whom 205 completed the household interview and examination, and 199 provided laboratory samples. Among enrollees, 82 (40%) were aged >50 years and participated in functional status measurement. We completed neighborhood observations on 93 street segments; an average of 2.2 (SD=1.6) study participants resided on each street segment observed. The community asset map identified 290 resources summarized in a Community Resource Guide given to all participants.Conclusions: The HCNI communityacademic partnership has built a framework to assess and document the individual, social, and community factors that may influence clinical and social outcomes in a community at high-risk for preventable chronic disease. Our project suggests that a community collaborative can use culturally and scientifically sound strategies to identify community-centered health and social needs. Additional work is needed to understand strategies for developing and implementing interventions to mitigate these disparities. Ethn Dis. 2016;26(1):123-132; doi:10.18865/ed.26.1.123

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Neighborhood socioeconomic disadvantage and mortality after stroke

Cited by 83 publications

References 32 publications

Socioeconomic Status and the Quality of Acute Stroke Care

Socioeconomic Status and the Quality of Acute Stroke Care

Residential zip code influences outcomes following hospitalization for acute pulmonary embolism in the United States

The Healthy Community Neighborhood Initiative: Rationale and Design

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