Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.
Center for Outcomes Research, Houston Methodist, Houston, TX; Division of Health Equity & Disparities Research, Center for Outcomes Research, Houston Methodist, Houston TX, USA.
Mayo Clin Proc. 2022 Feb;97(2):238-249. doi: 10.1016/j.mayocp.2021.08.024.
To examine the association of social determinants of health (SDOH) on prevalence of stroke in non-elderly adults (<65 years of age).
We used the National Health Interview Survey (2013-2017) database. The study population was stratified into younger (<45 years of age) and middle age (45 to 64 years of age) adults. For each individual, an SDOH aggregate score was calculated representing the cumulative number of individual unfavorable SDOH (present vs absent), identified from 39 subcomponents across five domains (economic stability, neighborhood, community and social context, food, education, and health care system access) and divided into quartiles (quartile 1, most favorable; quartile 4, most unfavorable). Multivariable models tested the association between SDOH score quartiles and stroke.
The age-adjusted prevalence of stroke was 1.4% in the study population (n=123,631; 58.2% (n=71,956) in patients <45 years of age). Young adults reported approximately 20% of all strokes. Participants with stroke had unfavorable responses to 36 of 39 SDOH; nearly half (48%) of all strokes were reported by participants in the highest SDOH score quartile. A stepwise increase in age-adjusted stroke prevalence was observed across increasing quartiles of SDOH (first, 0.6%; second, 0.9%; third, 1.4%; and fourth, 2.9%). After accounting for demographics and cardiovascular disease risk factors, participants in the fourth vs first quartile had higher odds of stroke (odds ratio, 2.78; 95% CI, 2.25 to 3.45).
Nearly half of all non-elderly individuals with stroke have an unfavorable SDOH profile. Standardized assessment of SDOH risk burden may inform targeted strategies to mitigate disparities in stroke burden and outcomes in this population.
探讨健康社会决定因素（SDOH）与非老年成年人（<65 岁）中风患病率的关系。
我们使用了国家健康访谈调查（2013-2017 年）数据库。研究人群分为年轻（<45 岁）和中年（45 至 64 岁）成年人。对于每个个体，计算了一个 SDOH 综合评分，代表了从五个领域（经济稳定、邻里、社区和社会环境、食品、教育和医疗保健系统获取）的 39 个子成分中确定的累积数量的不利 SDOH（存在与不存在），并分为四分位数（四分位数 1，最有利；四分位数 4，最不利）。多变量模型检验了 SDOH 评分四分位数与中风之间的关系。
研究人群中调整年龄后的中风患病率为 1.4%（n=123631；<45 岁患者占 58.2%（n=71956））。年轻成年人报告了约 20%的所有中风病例。患有中风的参与者对 39 项 SDOH 中的 36 项反应不佳；所有中风中有近一半（48%）是由 SDOH 评分最高四分位数的参与者报告的。随着 SDOH 四分位数的增加，调整年龄后的中风患病率呈逐步上升趋势（第一四分位数为 0.6%；第二四分位数为 0.9%；第三四分位数为 1.4%；第四四分位数为 2.9%）。在考虑了人口统计学和心血管疾病危险因素后，第四四分位数与第一四分位数的参与者发生中风的可能性更高（比值比，2.78；95%置信区间，2.25 至 3.45）。
近一半的非老年中风患者存在不利的 SDOH 特征。SDOH 风险负担的标准化评估可能为减轻该人群中风负担和结果的差异提供信息。
