The Effect of Socioeconomic Status on Outcome After Stroke

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Poverty can shorten the average person's life span by up to ten years. In the U. S., the disparity in mortality between social classes has worsened over the last 30 years. However, studies have shown that the general public fears significant disabilityafter stroke more than death, and yet the literatureregarding functional outcome after stroke is much less comprehensive. Low socioeconomic status (SES) has been shown to have a deleterious effect on functional outcome in many other disease processes. Similarly, low SES has been associated with a poorer health-related quality of life (HRQOL) in many diseases. While the HRQL has been examined in several studies regarding stroke, none to date have considered the direct impact of SES on outcome following stroke. Thus, we have identified a significant gap in our knowledgeregarding the effect of SES on outcome and qualityof life in stroke patients. This gap in knowledge makes it difficult to interpret studies of outcome after stroke, or studies of interventions designed to improve outcome after stroke From the literature examining SES in other disease processes, we have reason to believe that socioeconomic status will have a significant impact on functional outcome and quality of life after stroke. Therefore, the next logical step is to study the impact of socioeconomicfactors on functional outcome and quality of life after stroke, We hypothesize that having a lower SES at the time of stroke will negatively impact a stroke patient's functional outcome and HRQOL. We plan to study this question by utilizing a prospective cohort of stroke patients already being collected as part of the larger epidemiology of stroke project underway at the University of Cincinnati. We will evaluate both individual and aggregate indicators of SES, and to construct models describing the effect of these indicators on functional outcome and quality of life. We also plan to study the change over time in SES after stroke. At the completion of this study, we will have determined the effect of SES on a stroke patient's outcome and HRQOL, and will have also determined the most powerful indicators of SES to be used in future studies of SES and stroke: Given theenormous burden of stroke on our nation and the ever-rising costs of health care, the need for a specialist that canbridge the gap between stroke care and socioeconomics is evident. It is my ultimate goal to become an expert in outcomes research andthe socioeconomics of medicine, andto useclinical research to improve the lives of stroke patients from all social classes..