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Yadav RS, Chaudhary D, Avula V, Shahjouei S, Azarpazhooh MR, Abedi V, Li J, Zand R. Social Determinants of Stroke Hospitalization and Mortality in United States' Counties. J Clin Med 2022; 11:jcm11144101. [PMID: 35887865 PMCID: PMC9320068 DOI: 10.3390/jcm11144101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Stroke incidence and outcomes are influenced by socioeconomic status. There is a paucity of reported population-level studies regarding these determinants. The goal of this ecological analysis was to determine the county-level associations of social determinants of stroke hospitalization and death rates in the United States. (2) Methods: Publicly available data as of 9 April 2021, for the socioeconomic factors and outcomes, was extracted from the Centers for Disease Control and Prevention. The outcomes of interest were “all stroke hospitalization rates per 1000 Medicare beneficiaries” (SHR) and “all stroke death rates per 100,000 population” (SDR). We used a multivariate binomial generalized linear mixed model after converting the outcomes to binary based on their median values. (3) Results: A total of 3226 counties/county-equivalents of the states and territories in the US were analyzed. Heart disease prevalence (odds ratio, OR = 2.03, p < 0.001), blood pressure medication nonadherence (OR = 2.02, p < 0.001), age-adjusted obesity (OR = 1.24, p = 0.006), presence of hospitals with neurological services (OR = 1.9, p < 0.001), and female head of household (OR = 1.32, p = 0.021) were associated with high SHR while cost of care per capita for Medicare patients with heart disease (OR = 0.5, p < 0.01) and presence of hospitals (OR = 0.69, p < 0.025) were associated with low SHR. Median household income (OR = 0.6, p < 0.001) and park access (OR = 0.84, p = 0.016) were associated with low SDR while no college degree (OR = 1.21, p = 0.049) was associated with high SDR. (4) Conclusions: Several socioeconomic factors (e.g., education, income, female head of household) were found to be associated with stroke outcomes. Additional research is needed to investigate intermediate and potentially modifiable factors that can serve as targeted interventions.
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Affiliation(s)
- Randhir Sagar Yadav
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL 32207, USA
| | - Durgesh Chaudhary
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA; (V.A.); (J.L.)
| | - Shima Shahjouei
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
| | - Mahmoud Reza Azarpazhooh
- Departments of Clinical Neurological Sciences and Epidemiology, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Vida Abedi
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA;
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA; (V.A.); (J.L.)
| | - Ramin Zand
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
- Neuroscience Institute, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence:
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