Introduction: Social determinants of health (SDoH) are recognized as key contributors to adverse cardiovascular outcomes. However, the magnitude of the association between stroke and race-gender demographics has not been well characterized. This study aimed to evaluate the association between SDoH and stroke across different races and age groups. Methods: We conducted a retrospective cross-sectional analysis of the 2001-2018 NHANES, applying 18-year sampling weights across 9 survey cycles restricted to the fasting subsample. Variables with >10% missingness were imputed using fully efficient fractional imputation. Eight SDoH indicators, as shown in Table 1, were assessed. A cumulative SDoH score (0-8) was calculated and categorized into quartiles based on the unweighted distribution of the score. Continuous variables were summarized as weighted mean ± SE, and categorical variables as weighted percentages 95% CI. Associations between stroke and quartiles of SDoH score were evaluated using survey-weighted logistic regression, adjusting for demographics, laboratory, lifestyle factors, and comorbidities. Results: A total of 21,712 adults were included (mean age 46.6±0.2 years; 48.1%47.5-48.8 male; stroke prevalence 2.7%2.4-3.0). The mean SDoH score was 2.3±0.0, with median IQR of 31-4. Stroke prevalence by each SDoH indicator is shown in Table 1. In fully adjusted models, higher SDoH quartiles were associated with greater odds of stroke compared with Q1 (aOR Q2 1.63(1.21-2.20), p=0.002; aOR Q3 1.76(1.27-2.44), p=0.001; aOR Q4 2.35(1.82-3.03), p<0.001). Black participants had a higher risk of stroke than White (aOR Black 1.31(1.04-1.68), p=0.025). In sex-stratified analyses, associations were pronounced in men (aOR Q2 1.91(1.27-2.89), p=0.002; aOR Q3 1.83(1.13-2.97), p=0.015; aOR Q4 2.76(1.78-4.28), p<0.001). Among men, Black race was associated with higher odds compared to White (aOR Black 1.77(1.20-2.63), p=0.005). In women, higher SDoH quartiles remained associated with stroke (aOR Q3 1.81(1.15-2.85), p=0.010; aOR Q4 2.38(1.64-3.46), p<0.001), though no racial disparity was observed (aOR Black 1.04(0.77-1.40), p=0.811). Conclusion: Cumulative social disadvantage was independently associated with a higher risk of stroke, with especially strong effects observed among men and Black participants. Beyond optimizing control of traditional comorbidities, addressing adverse SDoH, particularly among Black men should be one of the prioritized strategies for stroke prevention.
Yongkiatkan et al. (Tue,) studied this question.