Other Titles
Rising Star Poster/Presentation
Abstract
Subarachnoid hemorrhage (SAH) is a life-threatening hemorrhagic stroke caused by bleeding in the arachnoid space of the brain, often resulting in long-term disabilities and poor quality of life (QOL). Individuals living in more advantaged neighborhoods report higher levels of QOL post-stroke, but little has been reported about QOL and neighborhood data after SAH.
This study sought to examine the relationship between measures of socioeconomic status (SES) and outcomes after SAH. SES encompasses a variety of factors. For this analysis, the area deprivation index (ADI) - a measurement of neighborhood socioeconomic disadvantage - was used as a surrogate for SES. We hypothesized that QOL is impacted by socioeconomic variables, predicting that SAH patients residing in areas of higher deprivation would report poorer QOL compared to those residing in areas of lower deprivation.
To test this hypothesis, this study examined the relationship between ADI, functional outcomes, and QOL at 3- and 12-months after SAH at a single stroke center. Demographic and clinical data was obtained from the patient, chart, or caregiver. Outcomes were obtained through interviews with the patient or caregiver. Functional outcome was assessed using modified Rankin scale (mRS), where 0 is no deficit and 6 is death. Physical QOL (PCS) was assessed using 20 items of the 36-item short form survey (sf36). The ADI was obtained using the University of Wisconsin School of Medicine Neighborhood Atlas and patient zip codes, where higher scores indicate increased deprivation.
A retrospective analysis of 215 SAH patients (mean age 54 years, 76% female, 84% white) used logistic and linear regression models to examine ADI measures (state decile, national percentile) and outcome variables controlling for SAH severity, age, race, and biological sex. Significant relationships were identified between ADI measures and PCS at both 3 and 12 months after SAH. For each one unit increase in ADI, the change in 3-month PCS was -3.711 (p < 0.001). For each one unit increase in ADI, the change in 12-month PCS was -4.364 (p < 0.001). There was no relationship between ADI measures and MRS at 3- or 12-months.
This analysis supports our hypothesis and suggests that individuals from areas of higher deprivation report poorer physical QOL, as measured by the sf36. Targeted interventions for patients in areas of higher deprivation warrant further investigation.
Notes
References:
Centers for Disease Control and Prevention. (2022, May 4). Stroke Signs and Symptoms | cdc.gov. Centers for Disease Control and Prevention. https://www.cdc.gov/stroke/signs_symptoms.htm#:~:text=Call%209%2D1%2D1%20immediately
Ghoneem, A., Osborne, M. T., Abohashem, S., Naddaf, N., Patrich, T., Dar, T., Abdelbaky, A., Al-Quthami, A., Wasfy, J. H., Armstrong, K. A., Ay, H., & Tawakol, A. (2022). Association of Socioeconomic Status and Infarct Volume With Functional Outcome in Patients With Ischemic Stroke. JAMA Network Open, 5(4), e229178. https://doi.org/10.1001/jamanetworkopen.2022.9178
Grevitt, Michael P, et al. THE SHORT FORM-36 HEALTH SURVEY QUESTIONNAIRE in SPINE SURGERY. Vol. 79-B, no. 1, 1 Jan. 1997, pp. 48–52, https://doi.org/10.1302/0301-620x.79b1.0790048
Sigma Membership
Eta
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Case Study/Series
Research Approach
Pilot/Exploratory Study
Keywords:
Subarachnoid Hemorrhage, SAH, Socioeconomic Status, SES, Patient Outcomes
Recommended Citation
Chung, Michelle; Deng, Zhirui; Ren, Dianxu; Isola, Kelly; and Crago, Elizabeth, "Association Between Area Deprivation Index and Outcomes After Subarachnoid Hemorrhage" (2025). Creating Healthy Work Environments (CHWE). 99.
https://www.sigmarepository.org/chwe/2025/presentations_2025/99
Conference Name
Creating Healthy Work Environments
Conference Host
Sigma Theta Tau International
Conference Location
Phoenix, Arizona, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
None: Event Material, Invited Presentation
Acquisition
Proxy-submission
Association Between Area Deprivation Index and Outcomes After Subarachnoid Hemorrhage
Phoenix, Arizona, USA
Subarachnoid hemorrhage (SAH) is a life-threatening hemorrhagic stroke caused by bleeding in the arachnoid space of the brain, often resulting in long-term disabilities and poor quality of life (QOL). Individuals living in more advantaged neighborhoods report higher levels of QOL post-stroke, but little has been reported about QOL and neighborhood data after SAH.
This study sought to examine the relationship between measures of socioeconomic status (SES) and outcomes after SAH. SES encompasses a variety of factors. For this analysis, the area deprivation index (ADI) - a measurement of neighborhood socioeconomic disadvantage - was used as a surrogate for SES. We hypothesized that QOL is impacted by socioeconomic variables, predicting that SAH patients residing in areas of higher deprivation would report poorer QOL compared to those residing in areas of lower deprivation.
To test this hypothesis, this study examined the relationship between ADI, functional outcomes, and QOL at 3- and 12-months after SAH at a single stroke center. Demographic and clinical data was obtained from the patient, chart, or caregiver. Outcomes were obtained through interviews with the patient or caregiver. Functional outcome was assessed using modified Rankin scale (mRS), where 0 is no deficit and 6 is death. Physical QOL (PCS) was assessed using 20 items of the 36-item short form survey (sf36). The ADI was obtained using the University of Wisconsin School of Medicine Neighborhood Atlas and patient zip codes, where higher scores indicate increased deprivation.
A retrospective analysis of 215 SAH patients (mean age 54 years, 76% female, 84% white) used logistic and linear regression models to examine ADI measures (state decile, national percentile) and outcome variables controlling for SAH severity, age, race, and biological sex. Significant relationships were identified between ADI measures and PCS at both 3 and 12 months after SAH. For each one unit increase in ADI, the change in 3-month PCS was -3.711 (p < 0.001). For each one unit increase in ADI, the change in 12-month PCS was -4.364 (p < 0.001). There was no relationship between ADI measures and MRS at 3- or 12-months.
This analysis supports our hypothesis and suggests that individuals from areas of higher deprivation report poorer physical QOL, as measured by the sf36. Targeted interventions for patients in areas of higher deprivation warrant further investigation.
Description
This study investigated the relationship between socioeconomic status and outcomes after subarachnoid hemorrhage, focusing on how neighborhood socioeconomic disadvantage, measured by the area deprivation index, affects physical quality of life and functional outcome. This analysis showed that higher ADI scores, indicating greater deprivation, were significantly associated with lower physical QOL, but not functional outcomes. These results could be used to inform future interventions.