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Socioeconomic determinants of outcome after childhood arterial ischemic stroke
Lori C Jordan1, Nancy K Hills2, Christine K Fox2
1From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH. lori.jordan@vanderbilt.edu.
Insights
Lower income in children with arterial ischemic stroke (AIS) is linked to worse neurologic outcomes. This disparity in pediatric stroke recovery was observed regardless of rehabilitation access and warrants further study.
Area of Science:
- Neurology
- Pediatric Stroke Research
- Socioeconomic Determinants of Health
Background:
- Arterial ischemic stroke (AIS) in children presents unique challenges.
- Socioeconomic status (SES) may influence health outcomes and access to care.
- Understanding disparities in pediatric AIS is crucial for equitable care.
Purpose of the Study:
- To investigate the association between socioeconomic status (SES) and 1-year neurologic outcomes in children with AIS.
- To determine if lower SES correlates with reduced access to rehabilitation services post-stroke in pediatric patients.
Main Methods:
- Prospective enrollment of 355 children with AIS in the VIPS study (2010-2014) across 37 international centers.
- SES assessment via parental interview: income, education, and residence.
- Neurologic outcomes measured using Pediatric Stroke Outcome Measure scores at 12 months post-stroke.
Main Results:
- Very low household income (<$10,000 USD) was significantly associated with worse neurologic outcomes (OR 3.13, p=0.004) in univariate analysis.
- This association persisted in multivariable analysis after adjusting for stroke etiology (OR 3.17, p=0.02).
- No correlation found between income and the receipt of rehabilitation services, though service quality/quantity were not assessed.
Conclusions:
- Low income is a significant predictor of poorer neurologic outcomes in children with AIS.
- The disparity in outcomes is not explained by stroke characteristics or rehabilitation service utilization.
- Further research is needed to identify the underlying causes of this socioeconomic disparity in pediatric stroke.
Objective:
To determine whether lower socioeconomic status (SES) is associated with worse 1-year neurologic outcomes and reduced access to rehabilitation services in children with arterial ischemic stroke (AIS).
Methods:
From 2010 to 2014, the Vascular effects of Infection in Pediatric Stroke (VIPS) observational study prospectively enrolled and confirmed 355 children (age 29 days-18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars) at the time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure scores were categorized as 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome.
Results:
At 12 ± 3 months after stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income (
Conclusions:
In a large, multinational, prospective cohort of children with AIS, low income was associated with worse neurologic outcomes compared to higher income levels. This difference was not explained by stroke type, neurologic comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear and warrant further investigation.
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