Impact of Socioeconomic Status on Functional Outcome After Stroke in Ulaanbaatar, Mongolia

Stroke disproportionately affects socioeconomically deprived populations, which leads to poor outcomes in disadvantaged groups. This study aimed to assess associations of socioeconomic status (SES) and long- and short-term functional outcome after stroke in Mongolia.

A prospective, population-based incidence stroke study was performed in Ulaanbaatar, Mongolia, between 2019 and 2020. SES indicators were average household family income and highest level of education attainment. The primary outcome was an unfavorable change in functional outcome on the binary modified Rankin Scale (scores 3-6 versus 0-2) measured at 28, 90, and 365 days. Logistic regression was used to analyze the association of SES and outcomes. Generalized linear mixed-effects models were used to assess associations according to repeated measures of modified Rankin Scale over 12 months, and a mediation analysis aimed to determine the mechanism by which SES affects outcome.

A total of 2205 patients (mean age, 58.0±12.8 years; 1330 [60.3%] men) were included. Patients with high-level family income were less likely to have unfavorable short-term (adjusted odds ratio, 0.36 [95% CI, 0.26-0.49]) and long-term (adjusted odds ratio, 0.41 [95% CI, 0.30-0.58]) outcomes. Patients with higher SES experience faster recovery from disability within 1 year, and patients with intracerebral hemorrhage have the slowest recovery rate among the stroke subtypes. Mediation analysis revealed that the impact of SES on functional outcome was mostly direct rather than through other mediators.

Patients with higher SES exhibit a better recovery pattern up to 1 year after stroke. SES directly and significantly influenced stroke outcome.