Sociodemographic Predictors of Neurological Outcomes and Quality of Life in Acute Stroke Patients: A Hospital-based Prospective Study from South India

Abstract Introduction: Stroke remains a major cause of death, disability, and reduced quality of life worldwide, with a disproportionate burden in low- and middle-income countries. In India, inequalities in income, occupation, education, and access to preventive care may influence stroke severity, time-to-presentation, recovery, and health-related quality of life; however, prospective hospital-based data addressing these factors remain limited. Methods: This prospective, observational study was conducted at a tertiary care center in southern Tamil Nadu, India, from January 2023 to December 2024. Two hundred and fifty consecutive adults with clinically and radiologically confirmed acute stroke were included. Baseline sociodemographic variables, vascular risk factors, treatment history, and acute-care details were recorded at admission. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcome was evaluated using the modified Rankin Scale (mRS) at discharge and at 30, 60, and 90 days. Quality of life was assessed during follow-up using the World Health Organization quality of life instrument-BREF and short form-36 instruments. Analyses were performed using IBM SPSS Statistics version 28.0. Associations were explored using Chi-square/Fisher exact tests and appropriate parametric or nonparametric tests, followed by multivariable logistic regression for poor 90-day functional outcome (mRS >2). Results: The mean age was 60 ± 11 years and 70.0% of participants were male. Married participants had better 90-day recovery than unmarried participants (mRS ≤2: 66% vs. 38%, P = 0.035). Manual laborers presented with greater neurological severity than others (median admission NIHSS 14 vs. 10; P = 0.042). Irregular health check-up practice was associated with more severe stroke (NIHSS >15: 41% vs. 19%; P = 0.010). Low annual income (<₹2 lakh) independently predicted poor 90-day functional outcome (adjusted odds ratio 2.4, 95% confidence interval: 1.3–4.5). Overall quality of life improved over follow-up, but remained lower among older adults, patients with socioeconomic disadvantage, and those with smoking/tobacco or alcohol exposure. Telemedicine-assisted follow-up was associated with higher 90-day quality-of-life recovery, although this finding should be interpreted cautiously because assignment was nonrandomized. Conclusion: Sociodemographic disadvantage was closely linked to greater stroke severity, delayed recovery, and poorer quality of life. Alongside acute stroke care, equity-oriented strategies such as stronger preventive care, earlier risk-factor control, improved affordability, and structured post-discharge follow-up may improve the outcomes in the resource-constrained Indian settings.