Key result
Social determinants of health link to higher county-level stroke mortality, with distinct age-specific factors.
Why the study?
After decades of consistent decline, the US stroke death rate leveled off in 2013, particularly in younger individuals, and the role of social determinants of health in these trends was unclear.
Do social determinants of health influence trends in stroke mortality across different age groups in the United States?
Observational
Yes
Do social determinants of health influence trends in stroke mortality across different age groups in the United States?
p-value: p=<0.001
Improvements in the US stroke death rate are slowing and reversing in many counties, with distinct social determinants of health driving these trends in younger versus older individuals.
May warrant SDOH-informed county planning for stroke prevention; leaves open causal impact on age-specific mortality trends.
BACKGROUND AND OBJECTIVES: In 2017, the Centers for Disease Control and Prevention (CDC) issued an alert that, after decades of consistent decline, the stroke death rate levelled off in 2013, particularly in younger individuals and without clear origin. The objective of this analysis was to understand whether social determinants of health have influenced trends in stroke mortality. METHODS: We performed a longitudinal analysis of county-level ischemic and hemorrhagic stroke death rate per 100,000 adults from 1999 to 2018 using a Bayesian spatiotemporally smoothed CDC dataset stratified by age (35-64 years [younger] and 65 years or older [older]) and then by county-level social determinants of health. We reported stroke death rate by county and the percentage change in stroke death rate during 2014-2018 compared with that during 2009-2013. RESULTS: < 0.001). In contrast to the younger individuals, in older individuals, the associations with increased death rates were with more traditional social determinants of health such as the social deprivation index, urban location, unemployment rate, and proportion of Black race and Hispanic ethnicity residents. DISCUSSION: Improvements in the stroke death rate in the United States are slowing and even reversing in younger individuals and many US counties. County-level increases in stroke death rate were associated with distinct social determinants of health for younger vs older individuals. These findings may inform targeted public health strategies.
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Havenon et al. (2023) conducted an observational in Ischemic and hemorrhagic stroke. Social determinants of health was evaluated on County-level ischemic and hemorrhagic stroke death rate per 100,000 adults and percentage change during 2014-2018 compared with 2009-2013 (p=<0.001). Social determinants of health were associated with county-level increases in stroke death rates, with distinct factors affecting younger versus older individuals (P<0.001).
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