Impact of Multiple Social Determinants of Health on Incident Stroke.

Stroke; a Journal of Cerebral Circulation
Evgeniya ReshetnyakMonika M Safford

Abstract

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. 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. 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...Continue Reading

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Citations

Oct 27, 2020·Stroke; a Journal of Cerebral Circulation·Reed MszarKhurram Nasir
Oct 27, 2020·Stroke; a Journal of Cerebral Circulation·Lesli E SkolarusBernadette Boden-Albala
Mar 10, 2021·Brain and Behavior·András FolyovichGergely Toldi
May 28, 2021·Stroke; a Journal of Cerebral Circulation·Natalia S RostUNKNOWN DISCOVERY Investigators
Jun 19, 2021·Stroke; a Journal of Cerebral Circulation·Audrey C LeasureGuido J Falcone
Jul 3, 2021·Journal of the American Heart Association·Safi U KhanMohamad Alkhouli
Aug 17, 2021·Current Opinion in Cardiology·Ivy MannohErin D Michos

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