Abstract Body: Introduction
Late complications after stroke (LCAS), including cognitive symptoms, impact quality of life and recovery. It is not known if neighborhood-level measures of socioeconomic status (SES) influence LCAS. This study assessed associations between combinations of SES measures including neighborhood income inequality (Gini) and area deprivation index (ADI), and cognitive symptoms after acute ischemic stroke (AIS) in a hospital leveraging active surveillance of LCAS.

Methods
This retrospective cohort study included 570 patients hospitalized at Tufts Medical Center with AIS and with subsequent follow-up in the Stroke Clinic where clinicians routinely screen for LCAS symptoms between 0-12 months. Using zip code data at the time of hospitalization, patients were characterized as low Gini (n = 224) and high ADI (n = 325) by national and state means, respectively. These variables were combined indicating patients who were living in both a low Gini and high ADI neighborhood (n = 154) to evaluate the effects of living in a homogeneously deprived area. The multifactorial analysis assessed the frequency of cognitive symptoms, adjusting for basic demographics, NIHSS, thrombolysis, active LCAS surveillance, and ADI-Gini combination.

Results
There was no association between high ADI (OR: 0.74 – 1.70, p = 0.60) or low Gini (OR: 0.82 – 2.00, p = 0.26) alone and cognitive symptoms after AIS. However, the combined variable analysis demonstrated increased frequency of cognitive symptoms in the high ADI-low Gini group (OR: 1.01 – 2.60, p = 0.047). In this model, active surveillance of LCAS was significantly associated with a higher detection rate of cognitive symptoms (OR: 4.30 – 10.49, p < 0.001).

Conclusion
This study suggests that individuals living in homogeneously deprived neighborhoods report higher frequencies of cognitive symptoms after AIS. Further studies with increased power are needed to investigate the underlying causes of these disparities and to develop interventions to reduce these complications.