Food insecurity, neighborhood, lack of social support, linked to worse stroke recovery

EMBARGOED FOR RELEASE UNTIL 4:00 P.M. ET, WEDNESDAY, JUNE 18, 2025

Highlights:

• Having at least one social factor affecting health, like food insecurity or not having a safe place to live or enough social support, was linked to worse recovery after stroke.
• Food insecurity, the most common factor, was linked to having trouble moving, needing a breathing or feeding tube or hospice care.
• Even though they had worse recovery rates, people with these factors had better survival rates up to one year after stroke compared to those without negative social factors.
• This unexpected finding suggests worse recovery does not necessarily translate to poorer survival, and more research is needed to determine why.

MINNEAPOLIS — Having poor access to food, living in a disadvantaged neighborhood and not having strong friend and family support may lead to worse outcomes after stroke, according to a study published June 18, 2025, in Neurology^® Clinical Practice, an official journal of the American Academy of Neurology. Conversely, the study found that people with these negative social factors had better survival rates after stroke. The study does not prove that socioeconomic factors lead to worse outcomes and better survival from stroke; it only shows an association.

The study looked at people with intracerebral hemorrhage, which is caused by bleeding in the brain.

“A growing body of research suggests that social determinants of health, non-medical factors such as socioeconomic status, employment, social support networks and health care access play a crucial role in how people develop, recover and survive various health conditions,” said study author Fady T. Charbel, MD, of University of Illinois Chicago. “Our study found certain social disparities negatively impacted recovery after a bleeding stroke, yet surprisingly, these same factors were tied to a higher rate of survival, which reflects the complex connection between social factors and health outcomes.”

The study involved 481,754 people.

U.S. Census data and participants’ addresses were used to collect information on social factors such as food insecurity and neighborhood indicators such as access to safe housing, environmental quality and access to transportation and recreational spaces. Researchers also looked at civic participation and social and support networks.

The 240,877 people who had experienced at least one negative social factor were compared to 240,877 people who had no history of negative social factors. Of the group with negative social factors, 87% experienced food insecurity, 14% experienced a social disparity, and 8% experienced a neighborhood disparity. Food insecurity is not having enough food or enough affordable, nutritious food.

Researchers found food insecurity was associated with a 61% increased risk of movement problems, a 98% increased risk of having a feeding tube, double the risk of needing a breathing tube, and a 35% increased risk of hospice care.

Researchers looked at recovery within 30 days of stroke and survival rates at 90 days and one year after the stroke.

People who experienced at least one negative social factor were more likely to have worse outcomes than those who had not. They had a 2% rate of needing a breathing tube compared to 0.9%. They had a 3.2% rate for both needing a feeding tube or a wheelchair, compared to 1.5% and 2.5%, respectively, for those who did not experience negative social factors. They also had a higher rate of being readmitted to the hospital at 9.8% compared to 6.2%.

Conversely, researchers found those who experienced negative social factors actually had better survival rates when compared to those who had not experienced negative social factors. Three months after stroke, their survival rate was 78% compared to 73%. One year after stroke, they had a survival rate of 62% compared to 58%.

“One possible explanation for this unexpected finding is that people who experience social disparities were more likely to use life-sustaining interventions such as feeding and breathing tubes,” said Charbel. “Another potential factor is disparities in access to palliative care services. Our study highlights the need to address the root causes of these disparities such as poverty and inadequate health care in order to develop better care for people after they have a stroke.”

A limitation of the study was that researchers were unable to gather racial or ethnic information, so the findings may be different for specific groups.

Discover more about stroke at BrainandLife.org, from the American Academy of Neurology. This resource also offers a magazine, podcast, and books that connect patients, caregivers and anyone interested in brain health with the most trusted information, straight from the world’s leading experts in brain health. Follow Brain & Life^® on Facebook, X, and Instagram.

The American Academy of Neurology is the leading voice in brain health. As the world’s largest association of neurologists and neuroscience professionals with more than 40,000 members, the AAN provides access to the latest news, science and research affecting neurology for patients, caregivers, physicians and professionals alike. The AAN’s mission is to enhance member career fulfillment and promote brain health for all. A neurologist is a doctor who specializes in the diagnosis, care and treatment of brain, spinal cord and nervous system diseases such as Alzheimer's disease, stroke, concussion, epilepsy, Parkinson's disease, multiple sclerosis, headache and migraine.

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