A new study published in Neurology reveals that how well you fare after a stroke or other neurological event may come down to where you live.
The goal of the study was to examine the differences in health outcomes after a stroke and other conditions based on socioeconomic status. Researchers used three years worth of Medicare claims to identify nearly a million people aged 65 and older who had been hospitalized for various neurologic conditions like stroke, Alzheimer’s disease, Parkinson’s disease, epilepsy, coma, multiple sclerosis
The address of each of these patients was reviewed using a measurement called the Area Deprivation Index (ADI) to determine whether or not they lived in a socioeconomically disadvantaged neighborhood. The ADI takes things like the housing quality, education, income and employment of neighborhood residents to assign a score, and neighborhoods that score higher on the index are at a greater disadvantage. The study team then used these scores to look at which Medicare recipients died within a month after their hospitalization for one of the neurological conditions listed.
The result of the study showed mortality rates were certainly higher in the most disadvantaged neighborhoods, and they weren’t great for stroke victims regardless of how the socioeconomic status of the neighborhood.
According to the report, 14.6% of stroke victims in the most disadvantaged neighborhoods died within the first month after their stroke, compared to 14.1% in advantaged neighborhoods.
Mortality rates were better for other conditions, but discrepancies still existed by neighborhood type. For degenerative conditions like Alzheimer’s disease and Parkinson’s, 9.7% of the patients studied died within a month of hospitalization compared to 8.7% in advantaged neighborhoods. Another 7.7% died within a month of hospitalization for epilepsy in disadvantaged neighborhoods compared to 6.8% in advantaged neighborhoods.
Overall, after adjusting these numbers for age, gender and other health conditions, the research team concluded that people in disadvantaged communities who were hospitalized for a stroke had a 23% higher chance of dying within a month than people living in more advantaged areas. These rates were also higher for degenerative diseases (38% higher risk), epilepsy (34% higher risk), trauma-related coma (44%), and non-trauma-related coma (146%).
There was no difference in hospitalizations for people with multiple sclerosis by neighborhood, according to the study, nor were there significant differences in rates of hospital readmissions. The study also did not factor in patients who were transferred from their original hospital to another facility, possibly ruling out the inclusion of some of the sickest patients.
Regardless of the limitations, the study authors suggest that these results highlight the need for healthcare providers to examine neighborhood level access to care and how it can impact patient outcomes. The hope, according to the research team, is that this data can be used to help improve health equity and access regardless of neighborhood affluence.
