Abstract P245: Association Between Individual Socioeconomic Status and Discharge Dispositions to Home or Rehabilitation Following Incident Stroke Hospitalization: The Atherosclerosis Risk in Communities (ARIC) Study

Background: The contribution of socioeconomic status (SES) to discharge destination in stroke survivors is not known. Hypothesis: Discharge to home, as compared to inpatient rehabilitation, will be greater among stroke survivors with low, as compared to high SES. Methods: The study population included ARIC Study participants, enrolled in fee-for-service Medicare, aged 66 years or older, with incident ischemic or hemorrhagic stroke (1992-2017). Black participants from the Minneapolis and Washington County study centers were excluded due to low numbers. Individual SES was estimated from median household income and education. Discharge disposition was ascertained from CMS Medicare inpatient records. Logistic regression models with inverse probability of treatment weighting were used to estimate the effect of exposures, accounting for age, sex, race, study center, comorbidity, and stroke severity. The Elixhauser Comorbidity Index was used to as a measure of comorbidity burden. Stroke severity was estimated from discharge diagnosis and procedure codes obtained from Medicare hospitalization records. Results: Of a total 710 ARIC stroke survivors (mean age at discharge 76 (SD: 6.2) years, 30.1% (214 of 710) Black, 57.5% (408 of 710) women), 50.7% (360 of 710) were discharged home. Compared to high income, low and moderate income was associated with lower adjusted odds of discharge to home among White participants (AOR:0.8, 95% CI: 0.68-0.93) and AOR: 0.63, 95% CI: 0.57-0.69), respectively) and higher odds discharge to home among Black participants (AOR: 1.36, 95% CI: 1.07-1.73 and AOR: 1.43, 95% CI: 1.11-1.83, respectively). Low income was also associated with higher odds of discharge home among women. Adjustment for stroke severity and comorbidity did not attenuate estimates. No significant association between education and discharge disposition was observed. Conclusions: Low and moderate median household income is statistically significantly associated with discharge home among Black and female stroke survivors.