Lower Socioeconomic Status Linked to Worse Outcomes in Pediatric Arterial Ischemic Stroke

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The root causes of the disparity reported among families of different income levels are unclear and deserve additional investigation.
The root causes of the disparity reported among families of different income levels are unclear and deserve additional investigation.

Low income levels are associated with worse 1-year neurologic outcomes in pediatric patients with arterial ischemic stroke, according to the results of an observational study published in Neurology.

The investigators sought to examine whether low socioeconomic status (SES) is linked to worse 1-year neurologic outcomes and reduced access to rehabilitation services in children with arterial ischemic stroke. Between 2010 and 2014, the Vascular Effects of Infection in Pediatric Stroke (VIPS) study enrolled and confirmed a total of 355 children, aged 29 days to 18 years, who had arterial ischemic stroke, at 37 international centers. 

Markers of SES that were evaluated via parental interview included annual household income (in US dollars) at the time of study enrollment, maternal education level, and residence (rural/suburban/urban). Parental reports were used to measure the receipt of rehabilitation services. Pediatric Stroke Outcome Measure scores were categorized as follows: 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10.

At 12±3 months after experiencing a stroke, 320 children had documented outcome measurements available, including 15 patients who had died. Univariate analysis showed that very low income (ie <US$10,000) was the only SES marker to be associated with significantly worse outcomes (odds ratio [OR], 3.13; 95% CI, 1.43-6.88; P =.004). In multivariable analysis, which included adjustment for stroke etiology, this association persisted and remained statistically significant (OR, 3.17; 95% CI, 1.18-8.47; P =.02). Income was not linked to receiving rehabilitation services 1 year after stroke, but the quality and quantity of rehabilitation services were not evaluated.

The researchers concluded that the link between low outcome and worse neurologic outcomes was not explained by type of stroke, neurologic comorbidities, or reported use of rehabilitation services. Thus, the root causes of the disparity reported among families of different income levels are unclear and deserve additional investigation.

Reference

Jordan LC, Hills NK, Fox CK, et al; VIPS Investigators. Socioeconomic determinants of outcome after childhood arterial ischemic stroke [published online July 6, 2018]. Neurology. doi: 10.1212/WNL.0000000000005946

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