Abstract TP124: 90-Day Disability Outcomes and Stroke Etiology: An ALIAS 2 Secondary Analysis

Background: Acute ischemic stroke (AIS) treatment remains a leading cause of global morbidity and mortality despite advancements in therapeutic options. Cardioembolic AIS had previously been associated with the greatest long-term disability and mortality. Our aim is to provide an updated perspective of 90-day disability outcomes with regard to stroke etiology. Methods: This is a secondary analysis of the ALIAS 2 trial. The primary outcome was the 90-day mRS. Stroke etiology was defined based on TOAST criteria. Spearman’s Rho is used to determine correlation between etiology and mRS. Univariate and multivariate logistic regression models are fit to a binary stratification of our outcome (mRS 0-1 vs 2-6). Results: A total of 776 patients were enrolled between 2009 and 2012 with a mean (SD) age of 64.7 (12.7) years. The median (IQR) NIHSS was 11 (8, 17) with 55.3% being male, 76.7% white, and 89.7% having received IV TPA. Large artery atherosclerosis (LAA) (201/776, 25.9%), cardioembolism (271/776, 34.9%) and cryptogenic (196/776, 25.3%) were the most common AIS etiologies. The 90-day mRS had significant differences by TOAST category (rho = 0.013, p<0.001). Individuals with LAA had the highest mean 90-day mRS (Figure 1). LAA was associated with lower odds of good outcome in both univariate analysis (OR 0.68, 95% CI 0.48-0.96) and in a multivariate model (OR 0.66, 95% CI 0.45-0.97) adjusted for age, NIHSS, diabetes, hypertension, hyperlipidemia, sex, white race and administration of IV TPA. Conclusion: Our secondary analysis revealed that AIS with a NIHSS greater than 8 of LAA origin purported a worse 90-day disability outcome. This data may serve to remind clinicians that AIS from LAA may yield comparable or greater disability than cardioembolic AIS. Figure 1: Mean 90-day disability outcome based on TOAST classification. LAA purported worse mean disability outcomes compared to other grouped etiologies.

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The Association Between Alkaline Phosphatase and Neurological Outcome in Patients with Post-cardiac Arrest: a Secondary Analysis of Data from Belgium

10.21203/rs.3.rs-744547/v1 ◽

2021 ◽

Author(s):

jiacheng he

Keyword(s):

Alkaline Phosphatase ◽

Logistic Regression ◽

Cardiac Arrest ◽

Neurological Outcome ◽

Regression Models ◽

Secondary Analysis ◽

Adverse Outcomes ◽

Blood Biomarkers ◽

Logistic Regression Models

Abstract Background: Prognostication of the unfavourable neurological outcome(UNO) after Cardiac arrest(CA) is multimodal while blood biomarkers are an attractive option.Serum alkaline phosphatase(ALP) is shown to be associated with ischemic stroke and considered as an independent prognostic factor for long-term functional outcome after acute cerebral infarction.We aimed to study the association between ALP and UNO in 3 months in patients after CA.Methods:Review of consecutive patients admitted to the ICU at Erasme Hospital, Brussels (Belgium) following CA between January 2007 and December 2015. The outcome was the UNO in 3 months. We used multivariable logistic regression models to calculate the adjusted odd ratio (OR) with 95% confidence interval(CI). Interaction and stratified analyses were conducted according to Shock,Dobutamine.used,Hypertension,Cardiac.Etiology and Shockable.Rhythm.Results: We included 374 CA patients. The multivariate logistic regression analyses revealed that the risk of UNO in 3 months after CA was significantly associated with ALP.When ALP was Equal is divided in 3 groups, the risk of ALP>91 level and adverse outcomes was 1.7407 times of ALP<64 level (P for trend=0.19709).In the non-hypertension group, the risk of adverse outcomes increased with increased ALP by 1.018 (1.0041.01,1.032).Conclusions: ALP is an independent risk factor for the UNO in 3 months after CA, especially in non-hypertension. Elevated ALP was significantly associated with increased UNO in 3 months after CA. However, the prediction significance of ALP for long-term neurological outcome in patients after CA is needed further studied.

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Risk of Distal Embolization From tPA (Tissue-Type Plasminogen Activator) Administration Prior to Endovascular Stroke Treatment

Stroke ◽

10.1161/strokeaha.120.029025 ◽

2020 ◽

Vol 51 (9) ◽

pp. 2697-2704 ◽

Cited By ~ 1

Author(s):

Alexander C. Flint ◽

Andrew L. Avins ◽

Abigail Eaton ◽

Stephen Uong ◽

Sean P. Cullen ◽

...

Keyword(s):

Plasminogen Activator ◽

Artery Occlusion ◽

Tissue Type ◽

Large Artery ◽

Distal Embolization ◽

Stroke Treatment ◽

Tissue Type Plasminogen Activator ◽

Type Plasminogen Activator ◽

Iv Tpa

Background and Purpose: In large artery occlusion stroke, both intravenous (IV) tPA (tissue-type plasminogen activator) and endovascular stroke treatment (EST) are standard-of-care. It is unknown how often tPA causes distal embolization, in which a procedurally accessible large artery occlusion is converted to a more distal and potentially inaccessible occlusion. Methods: We analyzed data from a decentralized stroke telemedicine program in an integrated healthcare delivery system covering 21 hospitals, with 2 high-volume EST centers. We captured all cases sent for EST and examined the relationship between IV tPA administration and the rate of distal embolization, the rate of target recanalization (modified Treatment in Cerebral Infarction scale 2b/3), clinical improvement before EST, and short-term and long-term clinical outcomes. Results: Distal embolization before EST was quite common (63/314 [20.1%]) and occurred more often after IV tPA before EST (57/229 [24.9%]) than among those not receiving IV tPA (6/85 [7.1%]; P <0.001). Distal embolization was associated with an inability to attempt EST: after distal embolization, 26/63 (41.3%) could not have attempted EST because of the new clot location, while in cases without distal embolization, only 8/249 (3.2%) were unable to have attempted EST ( P <0.001). Among patients who received IV tPA, 13/242 (5.4%) had sufficient symptom improvement that a catheter angiogram was not performed; 6/342 (2.5%) had improvement to within 2 points of their baseline NIHSS. At catheter angiogram, 2/229 (0.9%) of patients who had received tPA had complete recanalization without distal embolization. Both IV tPA and EST recanalization were associated with improved long-term outcome. Conclusions: IV tPA administration before EST for large artery occlusion is associated with distal embolization, which in turn may reduce the chance that EST can be attempted and recanalization achieved. At the same time, some IV tPA-treated patients show symptomatic improvement and complete recanalization. Because IV tPA is associated with both distal embolization and improved long-term clinical outcome, there is a need for prospective clinical trials testing the net benefit or harm of IV tPA before EST.

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Cardioembolic but Not Other Stroke Subtypes Predict Mortality Independent of Stroke Severity at Presentation

Stroke Research and Treatment ◽

10.4061/2011/281496 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Latha Ganti Stead ◽

Rachel M. Gilmore ◽

M. Fernanda Bellolio ◽

Anunaya Jain ◽

Alejandro A. Rabinstein ◽

...

Keyword(s):

Ischemic Stroke ◽

Small Vessel Disease ◽

Stroke Severity ◽

Large Artery ◽

Stroke Subtype ◽

Academic Center ◽

Ischemic Stroke Subtype ◽

Study Population ◽

Toast Criteria

Introduction. Etiology of acute ischemic stroke (AIS) is known to significantly influence management, prognosis, and risk of recurrence.Objective. To determine if ischemic stroke subtype based on TOAST criteria influences mortality.Methods. We conducted an observational study of a consecutive cohort of patients presenting with AIS to a single tertiary academic center.Results. The study population consisted of 500 patients who resided in the local county or the surrounding nine-county area. No patients were lost to followup. Two hundred and sixty one (52.2%) were male, and the mean age at presentation was 73.7 years (standard deviation, SD = 14.3). Subtypes were as follows: large artery atherosclerosis 97 (19.4%), cardioembolic 144 (28.8%), small vessel disease 75 (15%), other causes 19 (3.8%), and unknown 165 (33%). One hundred and sixty patients died: 69 within the first 30 days, 27 within 31–90 days, 29 within 91–365 days, and 35 after 1 year. Low 90-, 180-, and 360-day survival was seen in cardioembolic strokes (67.1%, 65.5%, and 58.2%, resp.), followed for cryptogenic strokes (78.0%, 75.3%, and 71.1%). Interestingly, when looking into the cryptogenic category, those with insufficient information to assign a stroke subtype had the lowest survival estimate (57.7% at 90 days, 56.1% at 180 days, and 51.2% at 1 year).Conclusion. Cardioembolic ischemic stroke subtype determined by TOAST criteria predicts long-term mortality, even after adjusting for age and stroke severity.

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Stroke Etiology and Outcomes after Endovascular Thrombectomy: Results from the SITS Registry and a Meta-Analysis

Journal of Stroke ◽

10.5853/jos.2021.00850 ◽

2021 ◽

Vol 23 (3) ◽

pp. 388-400

Author(s):

Marius Matusevicius ◽

Charith Cooray ◽

Viiu-Marika Rand ◽

Ana Paiva Nunes ◽

Tiago Moreira ◽

...

Keyword(s):

Meta Analysis ◽

Functional Independence ◽

Artery Occlusion ◽

Aggregate Data ◽

Large Artery ◽

Endovascular Thrombectomy ◽

Logistic Regression Models ◽

Risk Of Death ◽

Stroke Etiology ◽

Symptomatic Intracranial Hemorrhage

Background and Purpose The influence of stroke etiology on outcomes after endovascular thrombectomy (EVT) is not well understood. We aimed to investigate whether stroke etiology subgrouped as large artery atherosclerosis (LAA) and cardiac embolism (CE) influences outcomes in large artery occlusion (LAO) treated by EVT.Methods We included EVT treated LAO stroke patients registered in the Safe Implementation of Treatment in Stroke (SITS) thrombectomy register between January 1, 2014 and September 3, 2019. Primary outcome was successful reperfusion (modified Treatment in Cerebral Infarction 2b-3). Secondary outcomes were symptomatic intracranial hemorrhage (SICH), 3-month functional independence (modified Ranking Scale 0–2) and death. Multivariable logistic regression models were used for comparisons. In addition, a meta-analysis of aggregate data from the current literature was conducted (PROSPERO, ID 167447).Results Of 7,543 patients, 1,903 (25.2%) had LAA, 3,214 (42.6%) CE, and 2,426 (32.2%) unknown, other, or multiple etiologies. LAA patients were younger (66 vs. 74, P<0.001) and had lower National Institutes of Health Stroke Scale score at baseline (15 vs. 16, P<0.001) than CE patients. Multivariable analyses showed that LAA patients had lower odds of successful reperfusion (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.57 to 0.86) and functional independence (OR, 0.74; 95% CI, 0.63 to 0.85), higher risk of death (OR, 1.44; 95% CI, 1.21 to 1.71), but no difference in SICH (OR, 1.09; 95% CI, 0.71 to 1.66) compared to CE patients. The systematic review found 25 studies matching the criteria. The meta-analysis did not find any difference between etiologies. Conclusions From the SITS thrombectomy register, we observed a lower chance of reperfusion and worse outcomes after thrombectomy in patients with LAA compared to CE etiology, despite more favorable baseline characteristics. In contrast, the meta-analysis did not find any difference between etiologies with aggregate data.

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Abstract TP309: Utilization of IV-rtPA and Endovascular Therapy Use on Off-Hours vs. On-Hours: An Age Group Comparison

Stroke ◽

10.1161/str.51.suppl_1.tp309 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Smit D Patel ◽

Neel Patel ◽

Vasu Saini ◽

Mubashir Pervez ◽

Fadar Oliver Otite ◽

...

Keyword(s):

Nationwide Inpatient Sample ◽

Univariate Analysis ◽

Age Groups ◽

Primary Diagnosis ◽

Age Group ◽

Limited Data ◽

Logistic Regression Models ◽

National Estimates ◽

Multivariable Adjustment ◽

Iv Tpa

Introduction: Previous studies have yielded inconsistent results on whether weekend admission impacts the utilization of EVT and IV-rtPA. There is limited data available of whether age groups difference affects on use of IV-rtPA and EVT admitted during the off-hours. Our study aimed to investigate whether admission during the off-hours has any effect on the EVT & IV-rtPA utilization and is distributed uniformly across all age groups? Method: All adults admitted to US hospitals from 2005-2015 with a primary diagnosis AIS (n=4,520,516) were identified from the Nationwide Inpatient Sample using ICD-9 CM codes. Discharge weights were used to generate national estimates. On-hours vs. off-hours were defined using the weekend variable. Age groups were divided into 18-39, 40-59, 60-79 and ≥80 years. An age groupwise multivariable logistic regression models were used to compare odds of EVT and IV-rtPA use between on-hours vs. off-hours. Result: Total 4.5 million AIS population comprised 2.1% of 18-39 years, 20.0% of 40-59 years, 44.1% of 60-79 years and 34.0% of ≥80 years. Off-hours admissions comprised 25.7% of total AIS. Univariate analysis of off-hours vs. on-hours effects showed EVT utilization was 2.2% vs. 2.3% (P=0.50) and IV-tPA use was 7.9% vs. 7.3% (P=0.18) in 18-39 years. In 40-59 years age group, EVT 1.19% vs. 1.17% (P=0.74) and IV-tPA 6.2% vs. 5.7% (P <0.0001). In 60-79 years, EVT 0.95% vs. 0.96% (P=0.87) and IV-tPA 5.5% vs. 5.0% (P <0.0001) and in ≥80 years, EVT was 0.5% vs. 0.6% (P=0.12) and IV-tPA was 4.7% vs. 4.4% (P <0.0001). After a multivariable adjustment of patients and hospital characteristics, odds of EVT utilization was 0.85 (P=0.18) in 18-39 years, 0.92 (P=0.13) in 40-59 years, 0.91 (P=0.014) in 60-79 years and 0.84 (P=0.003) in ≥80 years. While in IV-tPA group, odds of IV-tPA use was 1.09 (P=0.16) in 18-39 years, 1.08 (P=0.001) in 40-59 years, 1.09 (P <0.0001) in 60-79 years and 1.07 (P=0.002) in ≥80 years. Conclusion: Our study concludes that there is a lower rate of EVT performed during off-hours in the age groups of 60-79 and ≥ 80 years old. However, There was no difference reported in the use of EVT in the younger population. It’s also interesting to note that there is a higher use of IV-rtPA during the off-hours in all age groups except age group 18-39 years.

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Long-term cardiovascular prognosis after transient ischemic attack

Neurology ◽

10.1212/wnl.0000000000004965 ◽

2018 ◽

Vol 90 (7) ◽

pp. e553-e558 ◽

Cited By ~ 4

Author(s):

Angel Ois ◽

Ana Zabalza ◽

Antia Moreira ◽

Elisa Cuadrado-Godia ◽

Jordi Jimenez-Conde ◽

...

Keyword(s):

Univariate Analysis ◽

Multivariable Analysis ◽

Large Artery ◽

Vascular Risk ◽

Vascular Events ◽

Acute Infarction ◽

Cardiovascular Prognosis ◽

Increased Risk ◽

Stroke Center

ObjectiveTo determine long-term cardiovascular risk after TIA and to identify the factors associated with increased risk.MethodsThis was a prospective observational registry of TIA patients admitted to the emergency room of our tertiary stroke center from June 2006 to January 2016. New vascular events (NVEs) were recorded from 3 months after TIA onset until June 2017, including both stroke and nonstroke events (coronary and peripheral disease). We registered TIA etiology, age, sex, vascular risk factors, radiologic data, and clinical TIA features and analyzed these variables in relation to NVE long-term risk.ResultsIn total, 676 patients 71.7 ± 13.7 years of age were included, with a mean follow-up of 48.8 ± 32.7 months. An NVE was detected in 173 patients (25.6%) without significant differences between event types (p = 0.84). Univariate analysis associated NVEs with etiologic subgroup, male sex, diabetes mellitus, hypertension, previous vascular disease, duration and clinical features of TIA, and signs of acute infarction. Multivariable analysis showed an independent association of NVEs with etiologic TIA subgroup, signs of acute infarction, and duration of TIA symptoms. Large artery atherosclerosis and cardioaortic embolism had the highest NVE risk, with a slightly higher percentage of nonstroke events. The small artery disease subgroup had the lowest NVE risk, with a higher percentage of stroke events.ConclusionsEtiology subgroup was the main factor determining high long-term risk of vascular events in patients with TIA. Large artery atherosclerosis carried the highest vascular risk, both nonstroke and stroke, followed by cardioaortic embolism.

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Pure Thalamic Infarct: 8-Year Follow-Up Study in a Hospital in China

Frontiers in Neurology ◽

10.3389/fneur.2021.715317 ◽

2021 ◽

Vol 12 ◽

Author(s):

He Liang ◽

Anand Karthik Sarma ◽

Zhenxing Wang ◽

Ming Mo ◽

Jianwen Lin ◽

...

Keyword(s):

Recurrent Stroke ◽

Smoking History ◽

Stroke Recurrence ◽

Large Artery ◽

Stroke Treatment ◽

Toast Classification ◽

Thalamic Infarct ◽

Thalamic Infarcts

Pure thalamic infarct is a rare lacunar stroke type, with little known about long-term outcomes. This 8-year, single-center, retrospective study evaluated the clinical background, etiology, Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification, and 8-year follow-up results in 27 patients with pure thalamic infarcts identified by MR diffusion-weighted imaging in Dalian, China. All patients presented chief complaints of limb weakness or sensory disturbances. Hypertension (24/27, 88.9%), diabetes (12/27, 44.4%), atrial fibrillation (1/27, 3.7%), hyperlipidemia (10/27, 37%), hyperhomocysteinemia (6/27, 22.2%), smoking history (10/27, 37%; 9/15, 60% for men; 1/12, 8.3% for women), and excessive alcohol consumption history (7/27, 25.9%; 7/15, 46.7% for men; 0 for women) were observed in our patient population. Based on TOAST classification, 1 patient had large artery atherosclerosis (7.14%), 23 had small vessel occlusion (SVO; 85.2%), and 3 patients were unidentified due to lack of cerebral angiography. The thalamic blood supply classification were as follows: 23 (85.2%), inferolateral territory; 1 (3.7%), tuberothalamic territory; 2 (7.4%), combination of tuberothalamic and paramedian arteries; 1 (3.7%), combination of inferolateral and paramedian arteries; 0, posterior choroidal arteries. During the 8-year follow-up, 3 patients died of colon cancer, multi-organ failure, and kidney failure, respectively; 7 presented with a recurrent stroke; while 10 recovered well with their risk factors under control. In conclusion, our cohort of pure thalamic infarcts were mainly due to SVO (TOAST), with hypertension as the main risk factor, and the inferolateral artery as the most implicated arterial territory. Less severe outcome or stroke recurrence are identified in long-term follow-up of pure thalamic infarcts. Other comorbidities would be cause of death in aged patients.

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Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

BMC Public Health ◽

10.1186/s12889-021-10463-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zijing Wang ◽

Wenjia Peng ◽

Mengying Li ◽

Xinghui Li ◽

Tingting Yang ◽

...

Keyword(s):

Older People ◽

Functional Disability ◽

Long Term Care ◽

Strong Association ◽

Binary Logistic Regression ◽

Term Care ◽

Logistic Regression Models ◽

Disease Pattern ◽

Long Term Care Insurance

Abstract Background Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. Methods We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. Results Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16–1.41) and IADL (OR 1.41, 95%CI 1.19–1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40–1.72). Conclusions Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

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COVID-19 Preventive Behaviours in Cameroon: A Six-Month Online National Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052554 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2554

Author(s):

Joseph Nelson Siewe Fodjo ◽

Leonard Ngarka ◽

Wepnyu Y. Njamnshi ◽

Leonard N. Nfor ◽

Michel K. Mengnjo ◽

...

Keyword(s):

Regression Models ◽

Health Personnel ◽

Online Survey ◽

Preventive Measures ◽

Face Mask ◽

Logistic Regression Models ◽

Adherence Score ◽

Preventive Behaviour ◽

Predictors Of Adherence

Since March 2020, the Cameroonian government implemented nationwide measures to stall COVID-19 transmission. However, little is known about how well these unprecedented measures are being observed as the pandemic evolves. We conducted a six-month online survey to assess the preventive behaviour of Cameroonian adults during the COVID-19 outbreak. A five-point adherence score was constructed based on self-reported observance of the following preventive measures: physical distancing, face mask use, hand hygiene, not touching one’s face, and covering the mouth when coughing or sneezing. Predictors of adherence were investigated using ordinal logistic regression models. Of the 7381 responses received from all ten regions, 73.3% were from male respondents and overall mean age was 32.8 ± 10.8 years. Overall mean adherence score was 3.96 ± 1.11 on a scale of 0–5. Mean weekly adherence scores were initially high, but gradually decreased over time accompanied by increasing incidence of COVID-19 during the last study weeks. Predictors for higher adherence included higher age, receiving COVID-19 information from health personnel, and agreeing with the necessity of lockdown measures. Meanwhile, experiencing flu-like symptoms was associated with poor adherence. Continuous observance of preventive measures should be encouraged among Cameroonians in the medium- to long-term to avoid a resurgence in COVID-19 infections.

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Intimate partner violence against women on the Colombia Ecuador border: a mixed-methods analysis of the liminal migrant experience

Conflict and Health ◽

10.1186/s13031-021-00351-y ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Colleen Keating ◽

Sarah Treves-Kagan ◽

Ana Maria Buller

Keyword(s):

Intimate Partner Violence ◽

Mixed Methods ◽

International Development ◽

Partner Violence ◽

Secondary Analysis ◽

Intimate Partner ◽

Psychological Consequences ◽

Colombian Women ◽

Restricted Mobility

Abstract Background Intimate partner violence (IPV) has serious long-term health and psychological consequences and is highly prevalent in Latin America and among displaced populations. Liminality - the ambiguous in-between state of individuals completing a migratory journey - represents a state of legal, economic, and physical insecurity. Through the framework of liminality, this analysis seeks to understand the unique challenges faced by displaced Colombian women in Ecuador including their experience of IPV. Methods We performed a secondary analysis of 15 in-depth interviews and 319 longitudinal surveys, conducted on the border of Ecuador and Colombia, following a sequential explanatory mixed-methods design. We analysed interviews thematically and mapped the main themes onto complementary quantitative variables. We conducted logistic regression with identified risk and protective factors (measured at time 1) and recent IPV (measured at time 2), controlling for demographic characteristics and IPV at time 1. Results Our mixed-methods analysis revealed four main mechanisms by which displacement influenced the social and economic realities of Colombian women years after crossing the border, compounding their risk of IPV and limiting their ability to escape it. Lack of legal residence and documentation, violence experienced along life course and migratory continuums which increased their risk for later revictimisation, social isolation including loss of support networks and restricted mobility and lastly, financial stress. Conclusions This research highlights the critical importance of supporting the economic and social integration of migrants and refugees in host communities, as well as the need to carefully consider migration-related vulnerabilities in IPV prevention and response interventions. As the regional refugee crisis grows, policy makers must consider how the long-term marginalisation of refugee women contributes to their victimisation. This research also supports the idea of incorporating gender synchronised, transformative IPV prevention and response programmes into migration-related and poverty alleviation international development efforts.

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