Social determinants of health and stroke risk: A dose-response analysis of cumulative socioeconomic burden in US adults.

BACKGROUND

Stroke is one of the leading causes of death and disability worldwide, with significant socioeconomic burdens. While traditional risk factors like hypertension are well-established, the role of social determinants of health (SDoH) in stroke risk remains understudied.

METHODS

We conducted a cross-sectional analysis of 35,741 NHANES participants (2005-2018), including 1,502 stroke cases. Eight SDoH indicators were evaluated using survey-weighted multivariable logistic regression, with adjustments for demographic and clinical covariates. Stratified analyses examined sex, race, and age variations.

RESULTS

Significant associations were found between adverse SDoH and stroke risk: unemployment (adjusted odds ratio (AOR) = 2.37, 95%CI:1.98-2.85), low income (AOR = 1.71, 95%CI:1.42-2.06), food insecurity (AOR = 1.25, 95%CI:1.06-1.47), and housing instability (AOR = 1.36, 95%CI:1.18-1.57). A clear dose-response relationship was observed between cumulative SDoH burden and stroke risk. Compared to those with no adverse SDoH, individuals with 1, 2, 3, 4, and 5 adverse SDoH had progressively higher adjusted odds ratios of 1.76 (95%CI:1.36-2.26), 2.15 (1.67-2.77), 3.04 (2.35-3.94), 4.21 (3.28-5.40), and 9.66 (6.86-13.61), respectively (P for trend < 0.0001). Subgroup analyses revealed that the associations between adverse SDoH and stroke risk varied significantly by sex and race, but not by age groups.

CONCLUSION

These findings demonstrate that SDoH independently and cumulatively influence stroke risk, with significant variations by sex and race. The results highlight the need for integrated prevention strategies addressing both medical risk factors and adverse SDoH, particularly for high-risk populations.