Key result
Higher neighborhood SVI linked to ~32% higher stroke rates.
Why the study?
Although individual neighborhood environmental factors are linked to stroke, less is known regarding the cumulative and interactive effects of neighborhood environmental features on incident stroke and severity.
Does neighborhood social and environmental burden affect incident stroke rates and stroke severity in Mexican American and Non-Hispanic White populations?
Does neighborhood social and environmental burden affect incident stroke rates and stroke severity in Mexican American and Non-Hispanic White populations?
Neighborhood social vulnerability is associated with higher incident stroke rates, particularly among Mexican Americans and in areas with high environmental burden, highlighting the importance of social determinants in stroke prevention.
Neighborhood SVI may warrant risk stratification attention in Mexican Americans; leaves open whether interventions targeting social vulnerability reduce stroke incidence.
Background: Aspects of neighborhood environment, such as socioeconomic status, air pollution, walkability, and extreme heat, are associated with stroke incidence and severity. Less is known about cumulative and interactive effects of a range of neighborhood environmental features. We evaluated the associations of neighborhood social and environmental burden with incident stroke and initial stroke severity and whether these associations differed by ethnicity. Method: All first-ever Mexican American (MA) and Non-Hispanic White (NHW) stroke cases between 2022-2024 in the Brain Attack Surveillance in Corpus Christi Project across 78 census tracts were included (n=1,215). Stroke severity was measured by National Institute of Health Stroke Severity (NIHSS) score. Census-tract level social vulnerability index (SVI) and environmental burden index (EBI) data came from the CDC in 2022 ( Table 1 ). Cumulative environmental burden was calculated by summing the ranks of SVI and EBI and converting to a percentile score ranging from 0-1 (larger →higher burden). Data on population at risk of stroke by census tracts were from the US Census. Poisson and linear regressions were used to estimate unadjusted and age-sex-ethnicity adjusted associations between three environmental burden indices and their interaction and incident stroke rates and NIHSS score, respectively, accounting for clustering within census tracts. Results: High cumulative burden (index>0.75) existed in 15 tracts ( Figure 1 ). Similar distributions were found for SVI and EBI. Higher SVI was associated with higher incident stroke rates in the fully adjusted model ( Table 2 ), overall (90 th vs 10 th percentile RR 1.32, 95% CI 1.03, 1.69) and among MAs (RR 1.53, 95% CI 1.08, 2.16). Higher EBI was associated with lower incident stroke rates among NHWs (RR 0.78, 95% CI 0.61, 0.99) but not MAs. A multiplicative interaction between SVI and EBI was found (P=0.02) in the full sample. In neighborhoods with high EBI (90 th percentile), higher SVI was associated with higher stroke rates (RR 2.62, 95% CI 1.59, 4.32) but not in neighborhoods with low EBI. No significant association between environmental burden and NIHSS was found. Conclusion: Neighborhood social environmental burden was associated with higher incident stroke rates, particularly among MAs and neighborhoods with high natural and built environment burden. Findings suggest the importance of neighborhood social and environmental burdens in primary prevention of stroke.
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Chen et al. (2026) studied this question. Higher neighborhood social vulnerability index (SVI) was associated with increased stroke rates, with RR 1.32 for the overall population and RR 1.53 for Mexican Americans.
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