# Social determinants of stroke prevalence in the United States adults: Analysis of 42 states using behavioral risk factor surveillance system 2022 data

## TL;DR

This study finds that experiencing four or more social disadvantages significantly increases stroke risk in U.S. adults, beyond known health factors.

## Contribution

The study introduces a composite index of social determinants of health to quantify their combined impact on stroke prevalence.

## Key findings

- Adults with four or more social determinants of health had 44% higher odds of prevalent stroke.
- Multimorbidity was associated with 3.52 times higher odds of prevalent stroke.
- Stroke prevalence was 3.44% for those with one adverse SDOH and 9.03% for those with four or more.

## Abstract

Social determinants of health (SDOH) significantly influence stroke outcomes and impose substantial cost burdens on the US health system. This study examined the composite effect of SDOH on prevalent stroke beyond clinical factors, highlighting comorbidity and structural inequalities using a statewide representative survey.

232,155 adults across 42 U.S. states were analyzed using the 2022 Behavioral Risk Factor Surveillance System (BRFSS). A composite index of SDOH was developed based on adverse exposures. A series of logistic regression models adjusting for sociodemographic, behavioral, and health-related covariates estimated the association between the SDOH index and prevalent stroke. An additional model examined the comorbid conditions. Weighted estimates were used, with 95 % CI and a significance level of p < 0.05.

The age-adjusted prevalence ranged from 3.44 % among those with one adverse SDOH to 9.03 % among those with four or more exposures. Four or more SDOH were associated with prevalent stroke (OR: 1.44, 95 % CI: 1.23, 1.68) in the fully adjusted logistic regression model. Multimorbidity was associated with 3.52 times higher odds of prevalent stroke (95 % CI: 3.11, 3.98).

Adverse exposures to ≥4 SDOH significantly predicted prevalent stroke among U.S. adults. Addressing causal pathways involving multimorbidity in the SDOH-stroke relationship is critical for targeted interventions.

•Stroke incidents impose a costly burden on the United States health system.•Social determinants of health play a key role in predicting stroke prevalence.•Across 42 states, approximately 4 in 100 adults experience a stroke.•Four or more social determinants of health significantly increase stroke risk.•Multimorbidity and multiple comorbid conditions substantially increase stroke risk.

Stroke incidents impose a costly burden on the United States health system.

Social determinants of health play a key role in predicting stroke prevalence.

Across 42 states, approximately 4 in 100 adults experience a stroke.

Four or more social determinants of health significantly increase stroke risk.

Multimorbidity and multiple comorbid conditions substantially increase stroke risk.