Social Factors Account for Much of the Black–White Stroke Recovery Gap

Researchers conducted a retrospective, population-based cohort study of acute ischemic stroke events in the Greater Cincinnati Northern Kentucky region from July 2019 to December 2020. Modified Rankin Scale (mRS) scores were assessed at discharge and at 3, 6, and 12 months. Of 2,796 patients, 2,537 survived the index event and were included; 32% were Black and 52% were women.

In models initially adjusted for age, sex, and time since stroke, Black race was associated with worse longitudinal mRS outcomes (common odds ratio [cOR], 2.61; 95% CI, 1.89–3.60). Adjustment for stroke severity and management reduced the cOR to 1.92 (95% CI, 1.43–2.60); additional adjustment for premorbid health reduced it to 1.43 (95% CI, 1.09–1.87). After social determinants were included, the association was no longer statistically evident (cOR, 1.09; 95% CI, 0.80–1.47). Findings were similar after excluding recurrent events, and there was no interaction between race and time since stroke.

The results identify persistent functional-outcome disparities and suggest that measured clinical and social factors account for much of the observed difference. The observational design cannot establish causation or show whether intervening on social determinants improves recovery; the authors call for further study.