Social Determinants of Health Framework Identifies Patients at Risk for Loss to Follow-Up After Stroke

Poststroke follow-up is associated with decreased rehospitalization and improved long-term outcomes. However, rates are variable and dependent on numerous factors, some of which are fixed (age, sex) while others are potentially modifiable (medical knowledge, access to care). The National Institutes of Health has identified key factors for healthcare inequity using a framework based on Social Determinants of Health. It is currently unknown which of these factors are the largest drivers of poststroke follow-up.

We evaluated a prospectively collected cohort of ≈2600 patients treated for ischemic stroke between 2014 and 2022. Potential variables were identified using the Social Determinants of Health framework and categorized as nonmodifiable or modifiable. T tests, χ², and regression analyses were used to investigate their association with the likelihood of follow-up.

Fifty-six percent of patients returned to the clinic. Greater degrees of impairment (due to stroke severity, advanced age, and premorbid condition), less education, scheduling inflexibility (due to occupation and employment status), and lack of home support were nonmodifiable factors associated with decreased follow-up rates. Greater postdischarge needs (evaluated by rehabilitation status and discharge disposition) along with less family involvement during the discharge process were also associated with lower rates.

This study identifies key factors associated with poor follow-up, defining an at-risk population. Modifiable factors may serve as targets for enhanced postdischarge support, suggesting that patients may benefit from interventions aimed at family support and improved communication with rehabilitation facilities. The approach underscores the value of integrating Social Determinants of Health considerations into patient management to ensure equitable and effective healthcare delivery.