Neighboorhood Disadvantage Is Associated With Hemorrhagic Stroke In Young Adults.

Introduction: Not only is hemorrhagic stroke (HS) in the young adult (≤50 years) frequently devastating, a racial disparity is established in this population. Traditional risk factors do not account for the disparity. The importance of environmental stressors in disease processes is recognized. Hence, we explored the hypothesis that neighborhood disadvantage, a measure of environmental stress, is associated with HS in young adults. Methods: We utilized demographic and clinical data from a prospective study of HS patients (spontaneous intracerebral and aneurysmal subarachnoid hemorrhages) at our institution between July 2015-December 2017. Patients were geocoded to 2010 US census tracts by address. Neighborhood concentrated disadvantage index (CDI) was calculated according to the PhenX Toolkit protocol using US Census data. Univariate comparisons were performed via Chi-square and t-tests. Multivariable logistic regression was used to analyze the probability of HS at an early age (≤50). All analyses were performed using SAS version 9.4. Results: 141 HS patients were enrolled; however, 15 non-Louisiana residents were excluded. Of 103 Louisiana residents, 53(51.5%) identified as white and 44(42.7%) as black race. Other races/ethnicities (n=6) were excluded due to small numbers. The proportion of Black patients aged 50 or younger was significantly greater than white patients (43% vs. 15%). Though not significant, males were more likely to experience HS at a young age. CDI scores were significantly higher, indicating greater neighborhood disadvantage, among patients ≤50 [mean CDI: 0.42 v -0.18]. Multivariable logistic regression results indicated that controlling for sex, the odds of HS at a young age were 4 times greater for blacks compared to whites [OR: 4.11 (1.55,10.94)]. While the association between CDI and HS at a young age was only marginally significant in the multivariable model (p=0.12), controlling for CDI did reduce the racial disparity [OR: 2.78 (0.94, 8.22)]. Conclusion: Our results suggest that differential exposure to neighborhood disadvantage is a contributing factor to the profound racial disparities for HS in individuals aged 50 or younger. More research is needed to determine distinct risk profiles for HS in this age group.