Reduced rehabilitation continuity after stroke in patients with substance use disorder based on a TriNetX retrospective cohort study

The incidence of stroke has increased in adolescents and young adults (AYAs) with substance use disorders (SUDs). AYAs have a 6.5-fold higher risk compared to non-users. Approximately 41% of AYAs with SUD experience concurrent mental health challenges, cognitive impairment, and socioeconomic disadvantage, all of which contribute to poorer health outcomes and reduced engagement in post-stroke rehabilitation. While most studies focus on acute outcomes, little is known about rehabilitation after stroke among patients with SUD. We conducted a retrospective cohort study using the TriNetX Research Network to identify adult stroke patients (≥ 18 years) with and without SUD between 2019 and 2023. Propensity score matching (1:1) was used to balance baseline characteristics, and rehabilitation utilization, defined as initiation of any rehabilitation service within 180 days post-stroke, was assessed across age (18–44, 45–64, 65–84, ≥ 85 years) and sex strata. A total of 49,966 patients with SUD and 725,256 without SUD were included. Patients with SUD exhibited significantly higher rehabilitation utilization rates (hazard ratio: 1.93; 95% CI: 1.88–1.98) but attended fewer sessions on average (mean: 2.16 vs. 2.68; p < 0.0001). Session frequency was based on the mean number of billed rehabilitation sessions. The greatest disparity was observed among males with SUD aged 45–64 years. These findings underscore the need for targeted interventions to address barriers to sustained rehabilitation engagement in this vulnerable population.