Background

There is a paucity of literature on the influence of social determinants of health on healthcare utilization and neurological outcomes within the neonatal arterial ischemic stroke (AIS) population. Thus, we aimed to describe patterns of healthcare utilization and neurological outcomes according to neighborhood-level material deprivation and ethnic diversity in Ontario, Canada.

Methods

Post-stroke rehabilitative care utilization was assessed using the Recovery and Recurrence Questionnaire. Pediatric Stroke Outcome Measure scores were dichotomized into good outcome (none or mild deficit) or poor outcome (moderate or severe) at latest follow-up. The Ontario Marginalization Index was used to quantify neighborhood-level material deprivation and ethnic diversity.

Results

We included 168 neonates diagnosed with AIS between January 1, 2004 and December 31, 2019. Significant association was found between rehabilitative care utilization and neurological outcomes (p = .048). A majority of patients from the most materially deprived and most ethnically diverse neighborhoods received either occupational therapy, physical therapy, speech therapy, or special education services. Poor language production at latest follow-up was associated with residence in the most materially deprived neighborhoods (χ2(1) = 7.52, p = .006).

Conclusion

We demonstrated that neurological outcome and healthcare utilization differed by neighborhood-level material deprivation and neighborhood-level ethnic diversity. While outcomes after neonatal stroke are generally favorable, identifying neighborhood-based indicators and predictors of poor outcomes may assist clinicians in provision of precise risk evaluation regarding recovery after stroke in the neonatal population.

Madeleine Harris
University of Toronto
Canada

Akshat Pai
The Hospital for Sick Children; University of Toronto
Canada

Daniel Nichol
The Hospital for Sick Children
Canada

Mahmoud Slim
The Hospital for Sick Children
Canada

Daune Macgregor
The Hospital for Sick Children
Canada

Ishvinder Bhathal
The Hospital for Sick Children
Canada

Mahendranath Moharir
The Hospital for Sick Children
Canada

Gabrielle deVeber
The Hospital for Sick Children
Canada

Liza Pulcine
The Hospital for Sick Children
Canada

Nomazulu Dlamini
The Hospital for Sick Children; University of Toronto
Canada