Role of Ethno-cultural Backgrounds in Childhood Stroke Outcomes

Objectives To characterize the role of ethnic and immigrant backgrounds in predicting outcomes following childhood arterial ischemic stroke in the most populated province of Canada, hypothesizing that ethnic and immigrant backgrounds influence outcome after stroke.

Methods Measures of ethnic and immigrant backgrounds included neighbourhood-level data on the proportion of non-White and non-Indigenous residents and the proportion of immigrants who arrived in Canada within the past five years. Patients’ postal codes were categorized as living in least, moderate, or most diverse neighbourhoods by using validated mapping techniques. Demographic, clinical, and radiological outcome predictors were examined along with measures of ethnic and immigrant backgrounds.

Results Childhood arterial ischemic stroke patients (N = 234) with stroke onset between January 1, 2004 and December 31, 2019 at a Level 2 (comprehensive) stroke centre were included. Predictors of poor outcome at 5 years post-onset of stroke included residence in neighbourhoods with the lowest levels of diversity (OR 5.77, p < 0.05) and involvement of both the anterior and posterior circulation (OR 5.36, p < 0.05). Although, moderate-to-severe deficits at presentation were not associated with poor outcome at 5 years post-onset of stroke, however, a trend was observed (OR 4.44, p = 0.05).

Conclusions The association between the level of diversity and poor outcome 5 years post-onset of stroke may be applicable to allocation of healthcare resources within the second-most diverse province in Canada. Thus, future studies exploring post-stroke outcomes should also consider ethnic and immigrant backgrounds within the broader social determinants of health.
Keywords: Pediatric, Stroke, Outcomes, Social Determinants of Health, Diversity