ABSTRACT NUMBER: ESOC2026A1906 ETHNIC AND SOCIOECONOMIC INEQUALITIES IN POST-STROKE COGNITIVE IMPAIRMENT AND QUALITY OF LIFE: THE SOUTH LONDON STROKE REGISTER 1995-2024

Abstract Background and aims Stroke disproportionately affects disadvantaged societal groups. Long-term and functional outcomes remain understudied. We investigated ethnic and socioeconomic inequalities in post-stroke cognitive status and health-related quality of life (HRQOL). Methods Population-based cohort of adults with stroke (n = 7,714), stratified by ethnicity and socioeconomic status (SES; measured by occupation). Associations between ethnicity or occupation and cognitive impairment (AMT < 8) or HRQOL (SF-12, physical/mental domain) at 3-months and 5-years post-stroke were calculated using multivariable regression analyses. Results At 3 months post-stroke, cognitive impairment was associated with Black Caribbean (OR 2.49 [95%CI 1.97-3.15]) and Black African ethnicity (2.44 [1.82-3.28]) and lower SES (1.69 [1.39-2.07]). These groups also experienced poorer physical HRQOL (Black Caribbean: β = -2.20 (P = 0.003); Black African: -1.97 (P = 0.013) and lower SES: -1.74 (P < 0.001). Conversely, Black Africans had better mental HRQOL than White participants (β = 1.72 (P = 0.006)). Adjustment for pre-stroke vascular risk factors and disability, and stroke type or severity had no attenuating effect. These associations persisted at 5 years post-stroke. During 1995 to 2022, 3-month cognitive impairment improved in all ethnic and socioeconomic groups, while 5-year cognition showed no significant trend in any group. HRQOL showed improvements only for 3-month physical HRQOL for White (P = 0.02) and higher-SES participants (P = 0.04). Conclusions We found persistent and partly worsening ethnic and socioeconomic inequalities in short- and long-term functional outcomes. Post-stroke surveillance and preventive strategies are needed to tackle the high and inequitable prevalence of cognitive impairment and poor physical quality of life in disadvantaged individuals. Conflict of interest Eva Emmett: nothing to disclose; Camila Pantoja_Ruiz: nothing to disclose; Amal Khanolkar: nothing to disclose; Charles Wolfe: nothing to disclose; Matthew O’Connell: nothing to disclose; Iain Marshall: nothing to disclose.