Abstract TMP10: Lower Household Income Is Associated With Worse Functional Outcomes In Hospitalized Stroke Patients With COVID-19 Across A Multi-institutional Chicago-wide Cohort

Introduction: The COVID-19 pandemic has exacerbated health disparities associated with socioeconomic status across the United States. However, little is known about how income mediates recovery and functional outcomes after stroke associated with COVID-19. Methods: This was a multi-institutional, retrospective study of consecutively hospitalized patients presenting in March through November 2020 to one of five comprehensive stroke centers in the Chicago area. Patients who tested positive for SARS-CoV-2 by RT-PCR assay of nasopharyngeal or oropharyngeal swabs and had radiographically confirmed stroke were included. Patient income was dichotomized at the median Chicago household income ($72800 annually). Logistic regression was used to examine the relationship between income and good functional outcome, defined as modified Rankin Scale (mRS) 0-3 at discharge, after ischemic stroke. Race and ethnicity were not included in the adjusted models given these variables were highly collinear with income. Results: Across five hospitals, 159 patients were included. Black patients comprised 48.1% of the sample, White patients 38.6%, and Hispanic patients 27.7%. Patients were most frequently publicly insured (60.7%), with severe COVID-19 symptoms requiring ICU care (49.7%) and symptomatic stroke at presentation (77.7%). Median patient income was $46,938 [SD: $32,460-63,219]. Ischemic stroke occurred in 115 (72.3%) patients (median NIHSS 7, IQR: 0.5-18.5); hemorrhagic stroke in 37 (23.7%); and cerebral venous sinus thrombosis (CVST) in 4 (3.4%). When controlling for age, sex, severe COVID-19 disease, and NIHSS, functional outcome from ischemic stroke was mediated by patient income. Patients with household income above the reported median for the Chicago area were more likely to have a good functional outcome at discharge (OR 7.53, 95% CI 1.61 - 45.73; P=0.016). Conclusions: Patients with lower household income were more likely to have poor functional outcomes, despite controlling for stroke and COVID-19 severity. Income may play a role in mediating recovery from COVID-19-associated stroke. Further studies are needed to evaluate the influence of other social determinants of health on COVID-19 associated stroke outcome and recovery.