Association of Neighborhood Recreation Centers and Poststroke Outcomes in a Population-Based Cohort

Abstract

Background: Higher neighborhood socioeconomic status has been favorably associated with stroke outcomes. This may be due to these areas having more beneficial resources such as recreational centers. We aimed to determine if neighborhood density of recreation centers is favorably associated with stroke outcomes. Methods: We conducted analyses of data from the Brain Attack Surveillance in Corpus Christi project, a cohort of stroke survivors ≥45 years of age residing in Nueces County, TX (2009–2020). We included non-Hispanic White and Mexican American incident stroke survivors, who were not institutionalized prestroke and completed baseline and follow-up assessments (N=1392). We calculated the density of fitness and recreational sports centers within their residential census tract during the year of their stroke. Outcomes included function (self-ratings on activities of daily living and instrumental activities of daily living), cognition (modified mini-mental state exam), depression (Patient Health Questionnaire-8), and quality of life (abbreviated Stroke-Specific Quality of Life Scale). We fit confounder-adjusted gamma-distributed mixed generalized linear models with a log link for each outcome and considered interaction with stroke severity. Results: On average, participants were 65 years old, 53% male, and 63% Mexican American. Median recreational centers were 1.60 per square mile (interquartile range, 0.41–3.06). Among moderate-severe stroke survivors, greater density of recreation centers (75th versus 25th percentile) was associated with more favorable function and possibly quality of life (activities of daily living/instrumental activities of daily living, 4.8% change [95% CI, −0.11% to −9.27%]; Stroke-Specific Quality of Life Scale, 3.7% change [95% CI, −0.7% to 8.2%]). Minimal nonsignificant differences were observed among the overall stroke population and those with mild stroke. Conclusions: The availability of recreation centers may be beneficial for poststroke function and quality of life among those with moderate-severe stroke. If further research confirms recreation centers to be beneficial, this could inform rehabilitation following stroke.

Neighborhood Resources and Health Outcomes Among Stroke Survivors in a Population‐Based Cohort

“… 68 The neighborhood resources we included are purported to be beneficial by stroke survivors, their caregivers, and older adults in general. 9 , 19 , 20 , 33 , 34 , 35 , 36 , 37 , 38 Our findings suggest that neighborhood resources may be beneficial for stroke recovery efforts; however, these benefits may be small and not noticeable by the survivors or their caregivers.…”

“…We previously reported neighborhood SES and density of recreation centers to have similar favorable associations among those with moderate–severe stroke. 8 , 9 We did not identify any studies considering the exposure of neighborhood resource density with poststroke outcomes; however, we did identify 3 publications evaluating a similar exposure: walk score. 22 , 23 , 24 Walk score is a measure of walkability based on the person's proximity to a variety of neighborhood resources.…”

“… 29 , 30 , 31 , 32 Resources were identified using the North American Industry Classification System and included places that have been reported as possible facilitators of physical activity, socialization, or cognitive stimulation outside one's home/work (Table S1 ). 9 , 33 , 34 , 35 , 36 , 37 , 38 These included stores; entertainment, intellectual, recreation, and religious centers and eating/drinking places. We linked resource density by year of stroke and survivor's residential census tract around the time of hospital admission.…”

“…Individual factors such as the severity of the stroke, sex, and race and ethnicity likely interact with the survivor's environment to influence poststroke outcomes. 7 , 8 , 9 Higher neighborhood socioeconomic status (SES) is associated with more favorable poststroke outcomes of functioning, quality of life (QOL), depression, stroke recurrence, and death, particularly among moderate–severe stroke survivors. 8 , 10 , 11 , 12 , 13 , 14 , 15 One potential explanation is that higher SES neighborhoods may have more resources providing beneficial opportunities for poststroke physical activity, socialization, and cognitive stimulation.…”

“… 17 , 21 , 22 , 23 , 24 A population‐based cohort study reported that neighborhood density of recreation centers may be beneficial to poststroke functioning and QOL among moderate–severe stroke survivors. 9 It remains unclear whether resources, overall, are beneficial to poststroke outcomes.…”