Food insecurity, neighborhood disadvantage, and lack of social support affect stroke outcomes

Having poor access to food, living in a disadvantaged neighborhood and not having strong friend and family support may lead to worse outcomes after stroke, according to a study published June 18, 2025, in Neurology^® Clinical Practice, an official journal of the American Academy of Neurology. Conversely, the study found that people with these negative social factors had better survival rates after stroke. The study does not prove that socioeconomic factors lead to worse outcomes and better survival from stroke; it only shows an association.

The study looked at people with intracerebral hemorrhage, which is caused by bleeding in the brain.

A growing body of research suggests that social determinants of health, non-medical factors such as socioeconomic status, employment, social support networks and health care access play a crucial role in how people develop, recover and survive various health conditions. Our study found certain social disparities negatively impacted recovery after a bleeding stroke, yet surprisingly, these same factors were tied to a higher rate of survival, which reflects the complex connection between social factors and health outcomes."

Fady T. Charbel, MD, study author of University of Illinois Chicago

The study involved 481,754 people.

U.S. Census data and participants' addresses were used to collect information on social factors such as food insecurity and neighborhood indicators such as access to safe housing, environmental quality and access to transportation and recreational spaces. Researchers also looked at civic participation and social and support networks.

The 240,877 people who had experienced at least one negative social factor were compared to 240,877 people who had no history of negative social factors. Of the group with negative social factors, 87% experienced food insecurity, 14% experienced a social disparity, and 8% experienced a neighborhood disparity. Food insecurity is not having enough food or enough affordable, nutritious food.

Researchers found food insecurity was associated with a 61% increased risk of movement problems, a 98% increased risk of having a feeding tube, double the risk of needing a breathing tube, and a 35% increased risk of hospice care.

Researchers looked at recovery within 30 days of stroke and survival rates at 90 days and one year after the stroke.

People who experienced at least one negative social factor were more likely to have worse outcomes than those who had not. They had a 2% rate of needing a breathing tube compared to 0.9%. They had a 3.2% rate for both needing a feeding tube or a wheelchair, compared to 1.5% and 2.5%, respectively, for those who did not experience negative social factors. They also had a higher rate of being readmitted to the hospital at 9.8% compared to 6.2%.

Conversely, researchers found those who experienced negative social factors actually had better survival rates when compared to those who had not experienced negative social factors. Three months after stroke, their survival rate was 78% compared to 73%. One year after stroke, they had a survival rate of 62% compared to 58%.

"One possible explanation for this unexpected finding is that people who experience social disparities were more likely to use life-sustaining interventions such as feeding and breathing tubes," said Charbel. "Another potential factor is disparities in access to palliative care services. Our study highlights the need to address the root causes of these disparities such as poverty and inadequate health care in order to develop better care for people after they have a stroke."

A limitation of the study was that researchers were unable to gather racial or ethnic information, so the findings may be different for specific groups.