Degree Name
DrPH (Doctor of Public Health)
Program
Public Health
Date of Award
8-2025
Committee Chair or Co-Chairs
David Andrew Shoham
Committee Members
Billy Brooks, Hadii Mohammed Mamudu, Qian Huang
Abstract
Introduction: Stroke is the fifth leading cause of death in Tennessee. Socioeconomic variables influence the delivery of stroke treatment and its outcomes. Despite advances in acute stroke care, the burden of stroke keeps increasing. This study aimed to explore literature on factors contributing to stroke care and outcomes in the U.S., assess the determinants of stroke patients’ outcomes, and examine the geographical disparities in stroke hospitalization and stroke death rate and their association with stroke care accessibility in Tennessee.
Methods: A scoping review was conducted using socio-ecological models to explore literature on factors contributing to stroke care and outcomes. A logistic regression analysis was conducted to assess the determinants of stroke patients' outcomes, utilizing data from the American Heart Association's GWTG ®- Stroke , to identify factors associated with poor outcomes in Tennessee. Finally, an ecological analysis was conducted at the county level using ArcGIS PRO and Online for spatial analysis and Generalized Linear Regression to examine how geographical disparities and stroke care accessibility are associated with stroke hospitalization and death.
Results: The scoping review found that individual or interpersonal characteristics, such as age, sex, and race, are significantly associated with stroke outcomes. Interpersonal factors like family support, knowledge, and awareness contribute to stroke outcomes. Organizational factors like Emergency Medical Services (EMS) stroke recognition, hospital capacity, and mode of transportation also affect stroke outcomes. In the second aim, age, private transport, hospital bed size, certification type, Time from symptom onset to intravenous therapy (OTT), and shorter hospital stays are associated with poor outcomes. The results of the third aim show that socioeconomic factors like older age, rural/urban status, and racial minorities are associated with stroke outcomes.
Implications: The findings underscore the necessity for a comprehensive public health approach to enhance stroke outcomes. Furthermore, policies targeting geographical disparities in stroke care, particularly in rural areas, are crucial, as access to stroke care markedly affects mortality rates. An integrated approach that combines targeted education, strong support systems, organizational enhancements, and community-level stroke prevention policy reforms is essential for decreasing stroke-related morbidity and mortality in Tennessee.
Document Type
Dissertation - embargo
Recommended Citation
Agbejimi, Omodele, "Exploring Factors Influencing Care and Outcome Among Stroke Patients in Tennessee" (2025). Electronic Theses and Dissertations. Paper 4557. https://dc.etsu.edu/etd/4557
Copyright
Copyright by the authors.