Abstract WMP34: Neighborhood Density Of Recreation, Civic, And Social Sites And Post-stroke Recurrence And Mortality

Introduction: Neighborhood socioeconomic status is associated with stroke recovery and mortality. Researchers suggest increased recreation, civic, and social sites (referred to as sites) may support physical, social, and cognitive activity resulting in more favorable outcomes. Hypothesis: Stroke survivors in neighborhoods with lower versus higher number of sites will have a higher rate of mortality and stroke recurrence; these associations will be modified by stroke severity, ethnicity, and sex. Methods: We included non-Hispanic white and Mexican American first-ever stroke survivors enrolled in the Brain Attack Surveillance in Corpus Christi project (2009-19), a population-based cohort in Nueces County, Texas. From a national database, we linked sites per square mile by census tract. We censored at second stroke (stroke recurrence model), death, or 1/1/2020, whichever occurred first. We fit cox regression models using a shared frailty model, adjusting for individual, interpersonal, and neighborhood factors. We considered interactions with stroke severity, sex, and ethnicity. We applied inverse probability weighting and multiple imputation to account for missing data. Results: There were 1,688 survivors; 408 deaths, 189 stroke recurrences, over median follow-up of 1372 days. Median age was 64 years, 74% with mild stroke, 54% male and 60% Mexican American. There was no association between site density and mortality (HR comparing 75 th to 25 th percentile=1.01, 95% CI=0.83-1.23) or stroke recurrence (HR=0.98, 95% CI=0.74-1.30). Stroke severity, sex, and ethnicity did not modify the effect of site density on post-stroke mortality (p=0.33, p=0.17, p=0.58, respectively) or stroke recurrence (p=0.43, p=0.91, p=0.99, respectively). Conclusions: We did not observe associations between neighborhood density of sites and post-stroke recurrence or mortality. Future research is needed to determine if other neighborhood features may support secondary stroke prevention or post-stroke survival.