Trifan Gabriela, Gallo Linda C, Lamar Melissa, Garcia-Bedoya Olga, Perreira Krista M, Pirzada Amber, Talavera Gregory A, Smoller Sylvia W, Isasi Carmen R, Cai Jianwen, Daviglus Martha L, Testai Fernando D
Department of Neurology and Rehabilitation, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
Department of Psychology, San Diego State University, San Diego, CA, USA.
J Stroke. 2023 Sep;25(3):361-370. doi: 10.5853/jos.2023.00626. Epub 2023 Aug 10.
Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US.
We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses.
For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P<0.0001). In bivariate analysis, income <$20,000, education less than high school, no health insurance, perceived discrimination, not currently employed, upper tertile for chronic stress, and lower tertiles for social support and language- and social-based acculturation were associated with stroke/TIA and retained further. A higher number of SDOH was directly associated with all individual VRFs investigated, except for at-risk alcohol, and with number of VRFs (β=0.11, 95% confidence interval [CI]=0.09-0.14). In the fully adjusted model, income, discrimination, social support, chronic stress, and employment status were individually associated with stroke/TIA; the odds of stroke/TIA were 2.3 times higher in individuals with 3 SDOH (95% CI 1.6-3.2) and 2.7 times (95% CI 1.9-3.7) for those with ≥5 versus ≤1 SDOH.
Among Hispanic/Latino adults, a higher number of SDOH is associated with increased odds for stroke/TIA and VRFs. The association remained significant after adjustment for VRFs, suggesting involvement of non-vascular mechanisms.
健康的社会决定因素（SDOH）是非医学因素，可能导致疾病的发生，在服务不足的人群中表现更为突出。我们的目标是确定在美国生活的西班牙裔/拉丁裔成年人中，不利的SDOH与自我报告的中风/短暂性脑缺血发作（TIA）及血管危险因素（VRF）之间的关联。
我们使用了西班牙裔社区健康研究/拉丁裔研究的横断面数据。通过问卷调查以及经过验证的量表和测量方法对SDOH和VRF进行评估。我们使用回归分析研究了SDOH（单独以及作为计数：≤1、2、3、4或≥5个SDOH）、VRF与中风/TIA之间的关联。
对于患有中风/TIA的个体（n = 388），其平均年龄（58.9岁）与未患中风/TIA的个体（n = 11,210；46.8岁；P < 0.0001）不同。在双变量分析中，收入低于20,000美元、教育程度低于高中、没有医疗保险、感知到歧视、目前未就业、慢性压力处于上三分位数以及社会支持和基于语言与社会的文化适应处于下三分位数与中风/TIA相关，并在后续分析中保留。除了有风险饮酒外，较高数量的SDOH与所有调查的个体VRF直接相关，并且与VRF的数量相关（β = 0.11，95%置信区间[CI] = 0.09 - 0.14）。在完全调整模型中，收入、歧视、社会支持、慢性压力和就业状况分别与中风/TIA相关；与≤1个SDOH的个体相比，有3个SDOH的个体中风/TIA的几率高2.3倍（95% CI 1.6 - 3.2），有≥5个SDOH的个体中风/TIA的几率高2.7倍（95% CI 1.9 - 3.7）。
在西班牙裔/拉丁裔成年人中，较高数量的SDOH与中风/TIA和VRF的几率增加相关。在对VRF进行调整后，这种关联仍然显著，表明存在非血管机制的参与。
