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Updated: Jun 9, 2026
09:10
Determining the Functional Status of the Corticospinal Tract Within One Week of Stroke
Published on: February 22, 2020
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Novel Network Analysis of County- and Individual-Level Factors Associated With Functional Outcomes After Stroke
Andrea A Jones1, Lily W Zhou1, Nichol Castro2
1Division of Neurology, Department of Medicine (A.A.J., L.W.Z., T.S.F.), The University of British Columbia, Vancouver, Canada.
Stroke
|March 21, 2025
Summary
Social determinants significantly impact stroke outcomes. Homelessness and lack of insurance are key factors influencing recovery, highlighting targets for intervention.
Area of Science:
- Complexity science
- Social epidemiology
- Clinical informatics
Background:
- Social determinants are recognized to influence stroke risk and patient outcomes.
- Complexity science offers a framework to analyze intricate relationships between social and clinical factors affecting stroke recovery.
Purpose of the Study:
- To examine the interrelations between county- and individual-level social and clinical determinants of stroke functional outcomes.
- To identify influential factors within a complex network influencing post-stroke recovery.
Main Methods:
- Retrospective cohort study of 2,961,664 stroke patients from 2218 US hospitals (2013-2019).
- Multilayer network analysis using mixed graphical models to represent social, clinical, and hospital encounter factors.
- Comparison of network structures and node centrality for patients with favorable (mRS 0-2) versus less favorable (mRS 3-6) outcomes.
Main Results:
- Social determinants exhibited greater overall influence in patients with less favorable outcomes.
- Homelessness and Black race were identified as key 'hub' nodes, mediating relationships between social and clinical factors.
- Lack of health insurance amplified the effects of social determinants, while higher county-level education and lower poverty correlated with faster arrival times.
Conclusions:
- Social determinants substantially influence functional outcomes post-stroke.
- County-level poverty impacts onset-to-arrival time and care quality.
- Health insurance status and homelessness represent critical, modifiable targets for interventions to improve stroke outcomes.
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