Data from: Socioeconomic determinants of outcome after childhood arterial ischemic stroke

Objective: To determine whether lower socioeconomic status (SES) is
associated with worse one-year neurological outcomes and reduced access to
rehabilitation services in children with arterial ischemic stroke (AIS).
Methods: From 2010-2014, Vascular Effects of Infection in Pediatric Stroke
observational study prospectively enrolled and confirmed 355 children (29
days -18 years) with AIS at 37 international centers. SES markers measured
via parental interview included annual household income (US dollars (USD))
at time of enrollment, maternal education level, and rural/suburban/urban
residence. Receipt of rehabilitation services was measured by parental
report. Pediatric Stroke Outcome Measure (PSOM) scores were categorized as
0-1, 1.5-3, 3.5-6, 6.5-10. Univariate and multivariable ordinal logistic
regression models examined potential predictors of outcome. Results: At
12±3 months post-stroke, 320 children had documented outcome measurements,
including 15 who had died. In univariate analysis, very low income
(<$10,000 USD), but not other markers of SES, was associated with
worse outcomes (OR 3.13, 95% CI:1.43-6.88; p=0.004). In multivariable
analysis, including adjustment for stroke etiology, this association
persisted (OR 3.17, 95% CI:1.18-8.47; p=0.02). Income did not correlate
with receiving rehabilitation services at one-year post-stroke; however,
quality and quantity of services were not assessed. Conclusions: In a
large multinational, prospective cohort of children with AIS, low income
was associated with worse neurological outcomes when compared to those
with higher income levels. This difference was not explained by stroke
type, neurological comorbidities, or reported use of rehabilitation
services. The root causes of this disparity are not clear, and warrant
further investigation.