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Socioeconomic Factors in Childhood Stroke Outcome

Neurology; ePub 2018 Jul 6; Jordan, Hills, et al

In a large, multinational, prospective cohort of children with arterial ischemic stroke (AIS), low income was associated with worse neurologic outcomes compared to higher income levels, a recent study found. This difference was not explained by stroke type, neurologic comorbidities, or reported use of rehabilitation services. From 2010 to 2014, the Vascular effects of Infection in Pediatric Stroke (VIPS) observational study prospectively enrolled and confirmed 355 children (aged 29 days-18 years) with AIS at 37 international centers. Socioeconomic status (SES) markers measured via parental interview included annual household income at the time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure scores were categorized as 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10. Researchers found:

  • At 12 ± 3 months after stroke, 320 children had documented outcome measurements, including 15 who had died.
  • In univariate analysis, very low income (<US $10,000), but not other markers of SES, was associated with worse outcomes.
  • In multivariable analysis, including adjustment for stroke etiology, this association persisted.

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