Social Determinants of Health Tied to Premature Stroke Mortality

Socioeconomics, access to health care, environmental factors, and other social determinants of health may be linked to premature stroke mortality, according to a recent study from JAMA Network Open. The study suggests a need to tailor health care strategies at the county-level in order to identify and provide care for counties with the highest risk of premature stroke mortality.  

The primary objective was “to examine between-county disparity in premature mortality due to stroke in the US, investigate county-level factors associated with mortality, and illustrate differences in mortality disparities by place of death and stroke subtype,” the study explained. 

Analysis was constrained to data from individuals between 25 and 64 years old, ages that signify premature stroke mortality. In focusing on county-level data rather than state-level data, the study concluded that different counties would need targeted strategies on a local level to prevent premature stroke mortality. 

Data was collected from the US National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC WONDER database), and researchers used information gathered from death certificates issued between 1999-2018. 

“Although a decline in mortality due to stroke has been noted in the US over the past decades, there remain substantial geographic disparities in mortality with higher rates in the southeastern US, termed ‘the stroke belt,’” the study stated. 

The “stroke belt” extends from the Ohio River Valley to the Mississippi River Valley, according to the study. The county with the highest mortality rate was 20.78 times as high as the county with the lowest mortality rate.  

“Percentage of rural residents, percentage of those older than 64 years, percentage of Black or African American, percentage of Asian, uninsured rate, and prevalence of physical inactivity were positively associated with both out-of-stroke-unit and in-hospital death rates,” the study maintained. 

While county-level mortality rates fluctuated by stroke subtypes, demographic composition was associated with premature stroke mortality for every subtype. The study looked at place of death (in or out of a stroke unit) to gain further insight into how these factors impacted mortality. Researchers found that 27.96 percent of deaths happened outside of a stroke unit. A lack of access to quality health care may be a significant reason for higher mortality rates, the study indicated. 

“Our findings on the association between mortality and four sets of county-level factors identified potentially modifiable county-level health care delivery and risk factors worthy of policy makers’ attention,” the study stated. 

The findings revealed that the various social determinants of health and environmental factors were more likely to affect deaths that occurred outside of a stroke unit rather than those that occurred in a hospital.  

Although premature stroke mortality rates decreased from 1999 to 2018, the between-county disparities show that more research into social determinants of health and strategizing on a local level could help to determine the cause behind the varying mortality rates by county. 

Recent studies have revealed that other health conditions have been linked to disparities due to social determinants of health. Socioeconomic factors may contribute to racial disparities in heart disease risk, specifically impacting young Black women, according to a recent study. Another study found that geographic isolation and socioeconomic status are tied to higher rates of mortality in rural areas, indicating a need to focus resources on regions with little access to health care.