Multiple Social Determinants of Health Linked with Increased Risk for Stroke

If you have multiple social determinants of health, your risk for stroke is nearly three-fold higher than for others, a new study suggests.

“We were focused on understanding how having multiple social determinants of health affect stroke risk, and we found significant health disparities that have a profound impact on people’s lives, especially in vulnerable populations,” said study author Evgeniya Reshetnyak, PhD, a senior research data analyst at Weill Cornell Medicine in New York City, in a press release. Results of the study were published in Stroke.

Researchers looking at how these determinants, and particularly the clustering of social determinants within on person, impact stroke risk included more than 27,000 participants from the REGARDS study in this analysis. Participants were drawn from a national, representative, prospective cohort of black and white adults aged 45 years or older. The primary outcome of interest was expert-adjudicated incidence of stroke. The authors used Cox proportional hazards models to look at associations between incident stroke and social determinants of health (adjusting for confounders).

According to the results, 1,470 stroke events were reported during the mean follow-up of 9.5 years. The researchers, after analysis, identified seven (out of 10) social determinants of health associated with increased stroke risk: race, education, income, zip code poverty, health insurance, social isolation, and residence in one of the 10 lowest-ranked states for public health infrastructure. The authors also reported a significant age interaction, as those younger than 75 years of age saw increases in stroke risk for each social determinant of health increase compared with those without any determinants of health.

“Our study shows that the risk of stroke is amplified among individuals with multiple social determinants of health factors, especially for those who are younger than 75 years old,” Dr. Reshetnyak said. “There is a cumulative effect of multiple social determinants of health. In fact, every additional disadvantage further increases stroke risk.”

According to the press release, black women in particular were more likely to have multiple social disadvantages, and those with more social determinants of health were more likely to have traditional risk factors such as hypertension and type 2 diabetes.

“There is a need for policies and interventions that specifically target younger vulnerable populations,” Dr. Reshetnyak said. “Early interventions are crucial for reducing stroke disparities. Although social determinants of health are difficult to change, their effect can be mitigated with timely interventions. However, programs may not be as effective at later ages when physiological factors may begin to dominate over social factors. ”