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Cited by 214Health disparities and outcomesAcute Ischemic Stroke ManagementPublic Health and Social Inequalities

Impact of multiple social determinants of health on incident stroke

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Reshetnyak, Evgeniya, Ntamatungiro, Mariella, Pinheiro, Laura C., Howard, Virginia J., Carson, April P., Martin, Kimberly D., Safford, Monika M.·2020·Stroke
DOI 10.1161/strokeaha.120.028530PMC PMC9264323
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Abstract

Background and Purpose: Social determinants of health (SDOH) have been previously associated with incident stroke. Although SDOH often cluster within individuals, few studies have examined associations between incident stroke and multiple SDOH within the same individual. The objective was to determine the individual and cumulative effects of SDOH on incident stroke. Methods: This study included 27 813 participants from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study, a national, representative, prospective cohort of black and white adults aged ≥45 years. SDOH was the primary exposure. The main outcome was expert adjudicated incident stroke. Cox proportional hazards models examined associations between incident stroke and SDOH, individually and as a count of SDOH, adjusting for potential confounders. Results: The mean age was 64.7 years (SD 9.4) at baseline; 55.4% were women and 40.4% were blacks. Over a median follow-up of 9.5 years (IQR, 6.0–11.5), we observed 1470 incident stroke events. Of 10 candidate SDOH, 7 were associated with stroke ( P <0.10): race, education, income, zip code poverty, health insurance, social isolation, and residence in one of the 10 lowest ranked states for public health infrastructure. A significant age interaction resulted in stratification at 75 years. In fully adjusted models, among individuals <75 years, risk of stroke rose as the number of SDOH increased (hazard ratio for one SDOH, 1.26 [95% CI, 1.02–1.55]; 2 SDOH hazard ratio, 1.38 [95% CI, 1.12–1.71]; and ≥3 SDOH hazard ratio, 1.51 [95% CI, 1.21–1.89]) compared with those without any SDOH. Among those ≥75 years, none of the observed effects reached statistical significance. Conclusions: Incremental increases in the number of SDOH were independently associated with higher incident stroke risk in adults aged <75 years, with no statistically significant effects observed in individuals ≥75 years. Targeting individuals with multiple SDOH may help reduce risk of stroke among vulnerable populations.

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  • Lower individual and neighborhood-level SES are associated with increased incidence and prevalence of CVD, including coronary heart disease, heart failure and stroke.

    “Lower individual and neighborhood-level SES are associated with an increased incidence and prevalence of CVD, including coronary heart disease, heart failure and stroke [1,[3], [4], [5], [6]].”

    From Income disparity and utilization of cardiovascular preventive care services among U.S. adults (2021) · cites this paper as [4]

    The Results report that income, education, and zip-code poverty were associated with incident stroke, with higher stroke risk as the number of social determinants increased among adults under 75. The paper does not report increased coronary heart disease or heart failure incidence or prevalence, nor stroke prevalence, so it supports only the stroke-incidence portion of the broader CVD claim. (LLM, conf=0.90)

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Authors
Reshetnyak, E., Ntamatungiro, M., Pinheiro, L. C., Howard, V. J., Carson, A. P., Martin, K. D., & Safford, M. M.
Affiliations
  • Cornell University (US)
  • Columbia University Irving Medical Center (US)
  • University of Alabama at Birmingham (US)
ORCID
Venue
Stroke
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-08
Volume
51
Issue
8
Pages
2445-2453
ISSN
  • 0039-2499 (ISSN-L)
  • 1524-4628
DOI
10.1161/strokeaha.120.028530
PMC
PMC9264323
OpenAlex
W3043380300
Cited by
214
References
4
Citations by year
2026: 28 · 2025: 48 · 2024: 44 · 2023: 42 · 2022: 25 · 2021: 22 · 2020: 5
FWCI
13.01
Type
journal article
Language
en
Open access
Locations
  • Stroke (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R01HL080477, R01HL165452)
  • National Institute of Neurological Disorders and Stroke (U01NS041588)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
social determinants of health, incident stroke, older adults, racial disparities, income, poverty, health insurance, social isolation, public health infrastructure, REGARDS study
MeSH terms
Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Poverty, Prospective Studies, Risk Factors, Socioeconomic Factors, Cohort Studies, Incidence, Stroke, Black People, White People, Health Status Disparities, Self Report, Social Determinants of Health

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