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How social factors can influence stroke risk

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It’s well established that social factors, such as income, race and education, are associated with poorer health. Now, researchers have found that some of these social determinants of health are linked to a cumulative increased risk of stroke.

Researchers in the US have found that people under the age of 75 with three or more social determinants of health (SDOH) are almost 2.5 times more likely to have a stroke than those who don’t have any.

Race, education, income and social isolation were associated with a higher risk of stroke, and the risk increased alongside the number of social determinants of health a person had.

The researchers analysed almost 28,000 people’s data from the REGARDS study, which includes black and white adults aged 45 and older from the US.

The study, which began in 2003, aimed to examine factors leading to higher stroke mortality rates.

They focused on 10 SDOH: race, education, income, postcode poverty, health insurance, social isolation, and residence in one of the 10 states that scores lowest for public health infrastructure.

They found that risk of stroke was 44 per cent higher for people with one SDOF, 82 per cent higher for those with two determinants, and two times higher in those with three or more.

People individuals with a greater number of SDOH, the paper states, were more likely to be black women, have low annual income, live in an impoverished neighbourhood, and live in a US state with poor public health infrastructure.

When the researchers, from Weill Cornell Medicine and University of Alabama at Birmingham, controlled for known stroke risk factors, including high blood pressure and diabetes, stroke risk increased 26 percent with one SDOH 38 per cent with two and 51 per cent with three.

For example, in the US, black people are more likely to have a stroke than white people, stroke risk factors explain only half of these cases, the paper, published in the journal Stroke, states.

These findings suggest that treating known stroke risk factors may be especially important for patients who have more DSOH that are linked to increased stroke risk.

“Physicians should pay particular attention to those patients with multiple determinants of health,” said study author Evgeniya Reshetnyak, senior research data analyst at Weill Cornell Medicine.

“Physicians should emphasise the importance of lifestyle changes and regular check-ups, discuss stroke risks with patients, and more aggressively control the stroke risk factors.”

“While social determinants of health are hard to change, we can mitigate the effects,” said Reshetnyak.

“Health care providers should consider heightening their vigilance to prevent the development of risk factors and achieve improved physiological risk factor control in persons with multiple SDOH on health outcomes.”

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