Abstract P881: Geospatial Analysis of Community and Patient Risk Factors for Poor Functional Outcome in Stroke

Introduction: Low neighborhood socioeconomic status has been associated with increased stroke risk, but it is not clear if this association is independent of individual socioeconomic status and clinical risk. Neighborhood racial segregation as defined by a racial isolation index (RI) has been shown to be associated with increased risk of stroke mortality. Using geospatial mapping techniques, we sought to determine the impact of neighborhood socioeconomic status and racial isolation on post-stroke functional outcome. Methods: Using our center’s prospective stroke registry, we matched charts for ischemic stroke patients seen between 1/1/2008 and 12/31/2018 with address data obtained from our hospital EMR for geospatial mapping. Racial Isolation (RI) and Neighborhood Deprivation Index (NDI) were calculated using census data. To assess the relationship between neighborhood factors and functional outcome, we used geographically weighted regression models. We fitted univariate and multivariate multinomial logistic regression models for functional outcome, and linear regression models for the percentage of poor functional outcome (defined as mRS 4-6). Significance was determined to be p < 0.05. Results: We included 5204 patients across 786 county census tracts. NDI (range -1.75 to 3.79) and RI (range 0 to 1) both appear to correlate visually with stroke rates of our patients across individual census tracts (Figure 1). Hypertension, diabetes, and dyslipidemia rates at individual and census tract level were significantly associated with poor functional outcome. NDI was not (OR 1.00 95% CI 0.99 - 1.00), but RI trended significant (OR 1.04 95% CI (0.99 - 1.09). Overall explanatory power was limited, warranting further investigation. Conclusions: Patient’s individual risk factors increased likelihood of poor functional outcome, but community segregation and socioeconomic deprivation indices are not predictors of poor functional outcome.