Very low neighbourhood income limits participation post stroke: preliminary evidence from a cohort study

Mary Egan, Lucy-Ann Kubina, Claire-Jehanne Dubouloz, Dorothy Kessler, Elizabeth Kristjansson, Michael Sawada

Neighbourhood income level is associated with the incidence of stroke and stroke-related mortality. It has also been linked to receipt of appropriate services, post discharge motor recovery and functional status following a stroke. We examined the impact of neighbourhood income on participation among community-dwelling stroke survivors during the two years following the stroke. Secondary analysis of data from a prospective cohort study. Participants were 67 individuals who were treated in acute care or rehabilitation following a first ever stroke, and were discharged to the community with FIM™ scores of at least 3 for comprehension, memory and problem solving. On this functional independence measure, these scores indicate that assistance is needed with related tasks up to 50 % of the time. Participation at 6, 9, 12, 18 and 24-months post stroke was measured using the Reintegration to Normal Living Index (RNLI). Income was measured by median neighbourhood annual family income according to postal code. The impact of very low neighbourhood income (median family income $20,000 Cdn or less) on participation at each follow-up period was determined controlling for potential confounders. Six (9.0 %) of the participants lived in very low-income neighbourhoods. These participants had average RNLI scores approximately 25 % lower at each follow-up period. While there was a trend for increasing participation with time among those in higher income neighbourhoods, this was not seen among very low-income neighbourhood participants. Very low me neighbourhood income had an independent effect on participation after controlling for discharge FIM™, 2-min walk test, gender, self-rated health, age, and emotional well-being at all follow-up periods. Our results indicate that very low neighbourhood income is linked with decreased participation during the first two years following stroke. Our findings indicate the need for further investigation of this relationship, and the importance of close follow-up of stroke survivors living in very low-income contexts.