Lower Socioeconomic Status Is Associated With Worse Childhood Arterial Ischemic Stroke Outcomes
Warren Lo, MD, Director, Stroke Clinic
An international study found that low household income is associated with poorer arterial ischemic stroke (AIS) outcomes in pediatric patients. This trend held true even when children from lower- and middle-income countries were excluded.
Senior author Warren Lo, MD, a member of the Division of Neurology at Nationwide Children’s Hospital, collaborated on the study with colleagues at the Hospital for Sick Children in Toronto and the University of California San Francisco.
“Good evidence exists that lower socioeconomic status and poverty are associated with a greater incidence, frequency and severity of stoke and worse outcomes in adults,” says Dr. Lo. “So, it seemed obvious that we should ask this question in children.”
The study included 355 children at 37 international centers in 9 countries between 2010 and 2014. Lower annual family income was associated with worse patient outcome. Very-low-income patients (<$10,000) had more than 3 times the risk for worse 1-year outcomes compared with high-income children (>$100,000).
Income did not correlate with the receipt of rehabilitation services, although the quality and frequency of services received was not assessed. Further, low income and decreased consciousness at presentation were highly correlated so that decreased consciousness was excluded from the analysis. This association, however, suggests that children from very-low-income families may have been far sicker at the time of presentation.
While the authors were not able to identify the cause for worse outcome after stroke in very-low-income children, they suggest that examination of unmeasured variables such as nutritional status could help clarify this relationship and warrant further investigation.
Dr. Lo, who is director of the Stroke Clinic at Nationwide Children’s and professor of Pediatrics at The Ohio State University College of Medicine, speculates that children who are extremely poor may have less access to high-quality health care, preventative health care and/or adequate vaccination. Previous studies found that children who were under-vaccinated were at a higher risk for developing stroke than children who were fully-vaccinated. Additionally, after a stroke, their parents may not have the resources or time to take off from work to commit to chronic rehabilitation if necessary.
The new publication was part of the larger, National Institutes of Health-funded Vascular Effects of Infection in Pediatric Stroke (VIPS) project for which Dr. Lo was a site investigator.
CITATION:
Jordan LC, Hills NK, Fox CK, Ichord RN, Pergami P, deVeber GA, Fullerton HJ, Lo W, For the VIPS Investigators. Socioeconomic Determinants of Outcome after Childhood Arterial Ischemic Stroke. Neurology. 2018 Aug 7; 91(6): e509-e516.
