Age-standardized prevalence of social determinants of health and associated race-ethnic disparities in stroke survivors

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Stroke is the third leading cause of death in the United States, with evident differences in health outcomes by race and socioeconomic factors. We aim to focus on social determinants of health by race/ethnicity and education level that greatly influences the health-related quality of life in stroke survivors. Method Using the 2017 Behavior Risk Factor Surveillance System (BRFSS) survey data, the direct age-adjusted prevalence was standardized to the 2000 projected US population. Multivariable weighted logistic regression models were post-estimated to calculate marginal effects of age, gender, education, and race on social determinants of health (housing insecurity, food insecurity, healthcare access hardship) at mean values of other predictors for stroke survivors. Models were adjusted for demographics, socioeconomic position, and stroke risk factors. Marginal effects (ME) reported as predicted probabilities. Result Among stroke survivors, nearly 27% reported housing insecurity and healthcare access hardship, and 48% reported food insecurity. The prevalence of housing insecurity was significantly higher among female (31.69%) than male (21.98%) survivors, and of race, highest among Non-Hispanic-Black (37.49%), lower among Non-Hispanic-Whites (23.83%), and lowest among Hispanics (17.20%) stroke survivors. In contrast, food insecurity was highest among Hispanics (63.71%). Healthcare access hardship was similar across the group with a comparatively lower prevalence in Non-Hispanic-White stroke survivors (25.32%). The predicted probability of housing insecurity was significantly higher among young adults compared to older adults aged 65 or above [ME 26.8 (95CI: 14.5-39.1 vs. ME 1.4 (95CI: 0.9-2.0)]. Of race, Black, NH stroke survivors showed a higher probability of housing insecurity [ME 12.4 (95CI: 6.3-18.3)], while the probability of food insecurity [ME 39.3 (95CI: 11.1-67.6)] and healthcare access was higher among other Non-Hispanic groups. The probability of any insecurities was similar among male and female stroke survivors. Stroke survivors with less than high school education showed a significantly higher probability of housing and food insecurity, in addition to healthcare access. Conclusion Social inequalities along with racial disparities in stroke survivors necessitate tailored intervention to reduce the burden of stroke. It is crucial to address socioeconomic factors such as housing, food, and healthcare access that promote the development of stroke risk factors. Abstract Figure.