Social Determinants of Health Among Non-Elderly Adults With Stroke in the United States

Safi U. Khan, Isaac Acquah, Zulqarnain Javed, Javier Valero-Elizondo, Tamer Yahya, Ron Blankstein, Salim S. Virani, Michael J. Blaha, Adnan A. Hyder, Prachi Dubey, Farhaan S. Vahidy, Miguel Cainzos-Achirica, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Objective: To examine the association of social determinants of health (SDOH) on prevalence of stroke in non-elderly adults (<65 years of age). Methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)238-249
Number of pages12
JournalMayo Clinic Proceedings
Issue number2
StatePublished - Feb 2022


  • Activities of Daily Living
  • Adult
  • Female
  • Health Behavior
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care/statistics & numerical data
  • Quality of Life
  • Residence Characteristics/statistics & numerical data
  • Risk Factors
  • Social Determinants of Health/statistics & numerical data
  • Socioeconomic Factors
  • United States

ASJC Scopus subject areas

  • Medicine(all)


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