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Health Inequity and Time From Pediatric Stroke Onset to Arrival

Akshat M Pai1,2,3, Teresa To2,3,4, Gabrielle A deVeber1,2,3

  • 1Division of Neurology (A.M.P., G.A.V., N.D.), The Hospital for Sick Children, Toronto, Canada.

Stroke
|March 15, 2024
PubMed

Insights

Pediatric stroke cases increased in deprived neighborhoods, with earlier emergency room arrivals over time. Further research is needed to understand the complex relationship between material deprivation and stroke onset-to-arrival times.

Area of Science:

  • Pediatric Neurology
  • Public Health
  • Health Equity Research

Background:

  • Stroke onset-to-arrival time is critical for treatment and outcomes.
  • Health inequities, influenced by structural, socioeconomic, and environmental factors, affect adult stroke onset-to-arrival.
  • This study investigates health inequity's impact on pediatric stroke onset-to-arrival.

Purpose of the Study:

  • To assess the association between health inequity and onset-to-arrival times in pediatric stroke patients.
  • To examine the role of neighborhood-level material deprivation as a proxy for health inequity.
  • To analyze trends in pediatric stroke incidence and arrival times in relation to socioeconomic factors.

Main Methods:

  • Retrospective observational study of children (28 days-18 years) with acute arterial ischemic stroke (AIS) from 2004-2019.
  • Neighborhood-level material deprivation derived from postal codes served as a health inequity measure.
  • Multivariable ordinal logistic regression analyzed the association between deprivation and onset-to-arrival (<6, 6-24, >24 hours), adjusting for confounders.

Main Results:

  • A total of 229 children were included; 61% were male, with a median age of 5.8 years.
  • An increasing proportion of pediatric AIS cases originated from the most deprived neighborhoods, with a trend towards earlier emergency room arrival (<6 hours, P=0.01).
  • Asian patients showed a higher prevalence in deprived neighborhoods (P=0.02) and material deprivation correlated with AIS risk factors (P=0.001).

Conclusions:

  • Pediatric strokes appear to be increasing in deprived neighborhoods, with earlier emergency room arrivals observed over time.
  • The reasons for these changes (increased incidence vs. improved awareness/diagnosis) require further investigation.
  • The interplay between AIS risk factors, material deprivation, and onset-to-arrival is complex and warrants deeper examination.
Abstract

Keywords:
childdelayed diagnosishealth equitysocial determinants of healthstroke

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