Investigating Multiple Mediators to Mitigate Socioeconomic Differences in Patient-Reported Outcomes After Stroke:...

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• Socioeconomic status (SES) significantly impacts patient-reported outcome measures (PROMs) 3 months post-stroke.
• Understanding the mechanisms behind these disparities is crucial for developing effective interventions.

Purpose of the Study:

• To investigate the underlying mechanisms of socioeconomic disparities in stroke outcomes.
• To identify potential interventional targets to equalize these differences.

Main Methods:

• Causal mediation analysis was used on data from 6910 first-time stroke patients (aged 18-64) in the Swedish Stroke Register (2015-2017).
• PROMs assessed activities of daily living, mood, fatigue, pain, and general health.
• Interventions simulated effects on smoking, metabolic health (diabetes, hypertension, statin use), and stroke characteristics.

Main Results:

• Low SES was associated with increased absolute risks of poor PROMs (6%-18%), most notably in general health (18.2%).
• Simulated interventions could reduce SES disparities by 14%-45%.
• Reducing smoking and improving metabolic health were identified as key interventions.

Conclusions:

• Working-age patients with low SES report more severe outcomes 3 months post-stroke.
• Targeted interventions for smoking, diabetes, hypertension, and high cholesterol in low-SES patients can mitigate outcome disparities.