Household income and postdischarge community activity after stroke: a multicenter prospective cohort study

Socioeconomic disadvantage is associated with poorer outcomes after stroke, but its relationship with everyday community activity after discharge is unclear, and income and education may not act alike. We examined associations of household income and spousal cohabitation with postdischarge community activity in a multicenter Korean cohort. At four South Korean rehabilitation centers, 153 community-dwelling stroke survivors completed the Physical Activity Scale for Stroke Patients in Daily Living; 103 with valid monthly household-income data formed the primary sample. Associations with total activity score were examined using Kruskal-Wallis tests and sequential linear regression with heteroscedasticity-consistent robust inference on a common complete-case sample, with center fixed effects, median regression, and adjustment for education as sensitivity analyses. Activity differed across the four income groups (H = 10.233, P = 0.017), concentrated in the highest-income group. Lower income predicted a lower activity score before adjustment (β = -23.62, P = 0.010), after demographic adjustment (β = -17.24, P = 0.041) and with center fixed effects (β = -18.41, P = 0.049), but not after adjustment for walking ability and cognition (β = -12.73, P = 0.139), in median regression (P = 0.243), or after adjustment for education (P = 0.167). Education was not associated with activity in any analysis, and spousal cohabitation showed no association. Household income was related to postdischarge community activity, but the association was statistically fragile and largely explained by functional and cognitive status.