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. 2022 Apr 27;5(4):e229178. doi: 10.1001/jamanetworkopen.2022.9178

Figure 3. Multistep Path Linking Socioeconomic Status to Functional Outcome After Stroke.

Figure 3.

A serial 2-mediator model shows that initial stroke severity indexes significantly mediate the association between income and functional outcome (modified Rankin Scale [mRS]). Within this model, all indirect pathways involving both infarct volume or admission National Institutes of Health Stroke Scale (NIHSS) score (whether alone or in series) were statistically significant. The direct path (which excludes a role for initial stroke severity indexes) becomes nonsignificant. Regression coefficients and P values correspond to models adjusted for age and sex. Arrowheads and green lines indicate the location and border of infarct, respectively. MRI indicates magnetic resonance imaging. The following 3 distinct indirect pathways were associated with 90-day disability: (1) decreased income to increased infarct volume to increased 90-day disability (standardized β, −0.008 [95% CI, −0.016 to −0.004]; P < .05); (2) decreased income to increased infarct volume to increased NIHSS score to increased 90-day disability (standardized β, −0.018 [95% CI, −0.032 to −0.004]; P < .05); and (3) decreased income to increased NIHSS score to increased 90-day disability (standardized β, −0.036 [95% CI, −0.061 to −0.012]; P < .05). Collectively these 3 indirect pathways account for 64% of the association between socioeconomic status and long-term disability (standardized β, −0.063 [95% CI, −0.095 to −0.029]; P < .05).