Open Access Research article

The association between socioeconomic status and disability after stroke: Findings from the Adherence eValuation After Ischemic stroke Longitudinal (AVAIL) registry

Janet Prvu Bettger1*, Xin Zhao2, Cheryl Bushnell3, Louise Zimmer2, Wenqin Pan2, Linda S Williams4 and Eric D Peterson2

Author Affiliations

1 Duke School of Nursing and Duke Clinical Research Institute, 307 Trent Drive, 511 DUMC 3322, Durham, NC 27710, USA

2 Duke Clinical Research Institute, Durham, NC 27710, USA

3 Wake Forest Baptist Medical Center, Winston-Salem, NC, USA

4 Roudebush Veterans Affairs Medical Center, Indianapolis, IN, USA

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BMC Public Health 2014, 14:281  doi:10.1186/1471-2458-14-281

Published: 26 March 2014



Stroke is the leading cause of disability among adults in the United States. The association of patients’ pre-event socioeconomic status (SES) with post-stroke disability is not well understood. We examined the association of three indicators of SES—educational attainment, working status, and perceived adequacy of household income—with disability 3-months following an acute ischemic stroke.


We conducted retrospective analyses of a prospective cohort of 1965 ischemic stroke patients who survived to 3 months in the Adherence eValuation After Ischemic stroke – Longitudinal (AVAIL) study. Multivariable logistic regression was used to examine the relationship of level of education, pre-stroke work status, and perceived adequacy of household income with disability (defined as a modified Rankin Scale of 3–5 indicating activities of daily living limitations or constant care required).


Overall, 58% of AVAIL stroke patients had a high school or less education, 61% were not working, and 27% perceived their household income as inadequate prior to their stroke. Thirty five percent of patients were disabled at 3-months. After adjusting for demographic and clinical factors, stroke survivors who were unemployed or homemakers, disabled and not-working, retired, less educated, or reported to have inadequate income prior to their stroke had a significantly higher odds of post-stroke disability.


In this cohort of stroke survivors, socioeconomic status was associated with disability following acute ischemic stroke. The results may have implications for public health and health service interventions targeting stroke survivors at risk of poor outcomes.

Ischemic stroke; Recovery; Disability; Socioeconomic position; Outcomes research