Abstract
Introduction: The availability of social services resources and stroke prevalence vary by geography. We assessed whether distributions of resources relevant to stroke survivors were clustered around areas of highest stroke prevalence in Ohio and if this varied by rurality. Methods: Census tract (CT) level self-reported stroke prevalence estimates (CDC PLACES-2019 Behavioral Risk Factor Surveillance System) was linked with sociodemographic and rurality data (2019 American Community Survey) and geographic density of resources in Ohio (2020 findhelp—search engine connecting individuals to a network of area social services). Resources were grouped into categories: housing, in-home, financial, transportation, education, and therapy. Negative binomial regression models estimated mean number of resources within 25 miles of a CT centroid and quartiles of stroke prevalence for each resource group and stratified by rurality status (rural, urban, and suburban). Models were sequentially adjusted for total population and CT level demographics. Results: The highest stroke prevalence quartile was associated with fewer resources within 25 miles compared to the lowest quartile overall (Prevalence Ratios (PR): 0.57-0.98), but this varied by rurality with the most pronounced disparity in rural CT ( p <0.05 for all resource categories). Rural CTs with the highest quartile stroke prevalence had fewer housing PR: 0.49 (95% CI: 0.32, 0.75), in-home PR: 0.31 (0.20, 0.49), and therapy PR: 0.23 (0.13, 0.43) resources compared to those with the lowest quartile stroke prevalence. Rural disparities became null after adjustment for federal poverty limit (FPL), supporting FPL as a mediator of this association. Conclusions: The inverse link between stroke prevalence and resource availability in rural Ohio is likely explained by geographic differences in poverty. Stroke-specific resource-related interventions are likely needed and should consider the role poverty.
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