Key result
≥3 adverse SDOH domains in early adulthood linked to ~100% greater early-onset stroke or TIA risk.
Why the study?
Despite increasing stroke incidence among younger adults, the associations of social determinants of health (SDOH) from early adulthood with stroke in this population are not well known.
Are adverse social determinants of health in early to mid-adulthood associated with an increased risk of early-onset stroke?
Cohort (n=5,114)
Are adverse social determinants of health in early to mid-adulthood associated with an increased risk of early-onset stroke?
Adverse social determinants of health experienced from early adulthood are associated with a dose-dependent increase in the risk of early-onset stroke.
Answers are grounded in this paper and cite their sources.
Adverse SDOH may elevate early stroke risk in young adults; extends longitudinal associations but leaves causal effects and interventions open.
BACKGROUND: Despite increasing incidence of stroke among younger adults, the associations of social determinants of health (SDOH) and stroke among younger adults are not well known. This study investigates the associations between SDOH from early adulthood and stroke in a prospective longitudinal cohort. METHODS: We studied participants enrolled in the CARDIA study (Coronary Artery Risk Development in Young Adults). Participants aged 18 to 30 years were enrolled in 1985 and followed through 2022. We investigated longitudinal, time-varying measures of SDOH classified into 5 distinct domains: economic (6 measures), education (1 measure), healthcare (4 measures), neighborhood (2 measures), and social/community (5 measures). The outcome was incident stroke or transient ischemic attack. We evaluated associations between individual SDOH and stroke using unadjusted Cox models. We then evaluated whether a greater cumulative number of adverse SDOH domains (each represented by 1 exposure selected by empirical techniques) was associated with stroke risk after adjustment for demographics. RESULTS: Among the 5114 participants (54.5% were female; baseline age, 25 years; and median follow-up, 37.9 years), 146 individuals experienced stroke or transient ischemic attack, all of which occurred <65 years. Household income (hazard ratio [HR], 1.24 per $10 000 lower [95% CI, 1.11–1.39]), education (HR, 0.93 per greater year [95% CI, 0.87–0.99]), neighborhood deprivation (HR, 1.21 [95% CI, 1.02–1.43]), and lacking health insurance (HR, 1.49 [95% CI, 1.05–2.11]) were associated with stroke risk. Those experiencing 2 adverse SDOH domains (HR, 1.65 [95% CI, 0.91–2.97]) or ≥ 3 adverse domains (HR, 2.00 [95% CI, 1.09–3.66]) had progressively higher stroke risk ( P trend =0.005). In interaction analyses, the association between income and stroke appeared stronger in Black participants ( P interaction =0.02) and women ( P interaction =0.02). CONCLUSIONS: In this young cohort followed through midlife, SDOH spanning several domains were associated with stroke risk. We also observed a dose-dependent response with the number of adverse SDOH domains experienced. Our results suggest that SDOH experienced throughout adulthood are relevant to future stroke risk.
No takes yet. Share an insight, caveat, or question.
Fleming et al. (2026) conducted a cohort in Early-Onset Stroke (n=5,114). Adverse social determinants of health (SDOH) vs. Fewer or no adverse SDOH domains was evaluated on Incident stroke or transient ischemic attack (HR 2.00, 95% CI 1.09-3.66, p=0.005). Experiencing ≥3 adverse social determinants of health domains in early adulthood was associated with a higher risk of early-onset stroke or TIA (HR 2.00; 95% CI 1.09-3.66; P trend=0.005).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: