Social determinants of health amplify stroke risk in adults younger than 75 years
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Among adults younger than 75 years, those with multiple social determinants of health were at more than a 2.5-fold greater risk for stroke than those without any, according to new data from the REGARDS study.
Determinants most strongly associated with stroke were race, education, income, ZIP code poverty, health insurance, social isolation and residence in one of the 10 lowest-ranked states for public health infrastructure.
Even after adjustment for confounding physiological factors, individuals younger than 75 years with three or more social determinants of health were at approximately 50% greater risk for stroke compared with those without any.
“Although social determinants of health are difficult to change, their effect can be mitigated with timely interventions. Such programs may not be as effective at later ages when physiological factors begin to dominate over social factors,” Evgeniya Reshetnyak, PhD, senior research data analyst in the department of medicine at Weill Cornell Medical College in New York, told Healio. “Physicians should pay special attention to those patients with multiple social determinants of health. When providing care to their patients with multiple social determinants of health, physicians should emphasize the importance of lifestyle changes and regular checkups, discuss stroke risk factors with them, more aggressively control risk factors, and recommend available outreach and educational programs that would help reduce risk of stroke.”
For this analysis published in Stroke, researchers assessed 27,813 participants in the REGARDS trial aged at least 45 years (mean age, 65 years; 55% women; 40% Black) to determine individual and cumulative impact of social determinants of health on stroke.
Among participants younger than 75 years, researchers observed an increasing trend in risk for stroke as the total number of social determinants of health increased compared with individuals without any (P for trend = .0002):
- one social determinant of health (HR = 1.26; 95% CI, 1.02-1.55);
- two social determinants of health (HR = 1.38; 95% CI, 1.12-1.71); and
- three or more social determinants of health (HR = 1.51; 95% CI, 1.21-1.89).
“The stress that is associated with limited resources has a debilitating toxic effect on the individuals’ psychological, social, and physical well-being, which is linked to poor health outcomes, and stroke in particular,” Reshetnyak said in an interview. “We found significant health disparities that have a profound impact on people’s lives.”
The relationship between social determinants of health and stroke did not reach statistical significance among participants aged at least 75 years (P for trend = .97).
“One open question is how much each of these social determinants of health contributes to the risk of stroke. If we wanted to change policy on the one factor with the greatest influence, what would that factor be,” Reshetnyak told Healio. “Additional social determinants of health such as perceived discrimination, police brutality, racial discrimination in our penal system or environmental factors were not available in our dataset.
“We started this study long before the current civil unrest around police brutality and institutional racism,” Reshetnyak said in an interview. “The fact that it is now being published is a fortunate coincidence, and we hope it underscores just how important these socially determined influences are and contributes to active change in our institutions to combat these threats to the public health.”
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