Jennifer Harris, MD
Health disparities have emerged as one of the great challenges to our health care system and a critical concern for the health of our U.S. population. Among the most dramatic disparities are seen in cardiovascular disease (CVD). Disparities in stroke outcomes are also widely reported in the literature. Whereas stroke rates in the U.S. have declined over the last decades, stroke mortality rates in nonwhites (predominantly Non-Hispanic (NH) Blacks) have remained substantially higher than in NH Whites . This disparity may be due to differences in stroke incidence, with relative risk=2.77 (95%CI 1.37-5.62) between NH blacks and NH whites among those <55 years of age and 2.23 (95%CI 1.66-3.00) in those >55 years of age . Data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study suggest that the prevalence of stroke risk factors, particularly hypertension and diabetes, while clearly higher among NH Blacks, account for only 40% of the Black-White disparities in stroke incidence. The reasons for the remaining 60% are elusive .
Various socioeconomic determinants of health have been shown to predispose patients to developing CVD and stroke. According to national health disparities data for cardiovascular disease outcomes, there are several social determinants of health (SDOH) that may help explain stroke disparities. SDOH are defined as economic and social conditions that influence individual and group differences in health status. SDOH include low education, low income, living in an impoverished area, social isolation, and lacking health insurance, among others. To further investigate the association between incident stroke and SDOH, Reshetnyak et al. analyzed data from the REGARDS study to determine the individual and cumulative effect of SDOH on incident stroke.