Jackson Aubrey
Impact of Utah’s Healthy Places Index on Stroke Outcomes in Utah: A Retrospective Analysis
Mentors: Michael Bounajem, MD
Department: Neurosurgery
Background: Stroke outcomes are influenced by various sociodemographic factors, including healthcare access. Tools like the Utah Healthy Places Index (HPI), the area deprivation index (ADI), and the Health Professional Shortage Areas (HPSA) use this information to stratify populations. This study investigates whether disparities in HPI, ADI, and HPSA scores correlate with differences in stroke follow-up and functional outcomes after treatment.
Methods: A retrospective chart review identified patients with large vessel occlusion treated with mechanical thrombectomy between 2016 and 2024. Data on demographics, comorbidities, treatment, HPI, ADI, HPSA, follow-up length, and functional outcomes defined by modified Rankin Score (mRS) was analyzed using a multivariable regression model.
Results: Among 330 patients (184 males, 146 females, mean age of 64 +/- 16.51), the mean HPI score was 48.83 +/- 30.20. The median mRS scores at discharge, 30-day, 90-day, and final follow-up were (3.00 +/- 1.81), (3.00 +/- 2.24), (4.00 +/- 2.29), and (3.00 +/- 2.20). The median TICI score was 3. HPI and ADI scores were not correlated with follow-up or mRS. However, follow-up rates decreased as HPSA score increased (OR 0.24, 95% CI 0.11 – 0.36, p<0.001) and as frailty score increased (OR 0.97, 95% CI 0.96 – 0.99, p<0.001). Favorable mRS decreased with increasing age, baseline mRS, and mRS at presentation and increased with final thrombolysis score.
Discussion: HPI and ADI were not predictors of follow-up or mRS, but higher HPSA scores demonstrated poorer follow-up, highlighting the need for targeted healthcare interventions.
