Cardiovascular disease refers to diseases of the heart and blood vessels, which include strokes, heart attacks, and other heart issues. Only about 20% of cardiovascular disease is caused by genetics; the remaining 80% is behavioral or environmental. That’s good news because it means you have some control over your risk of stroke or heart attack. While lifestyle choices are a major factor in strokes and heart attacks – food choices, sedentary lifestyle, smoking – there are socioeconomic factors, as well.

Social determinants of health

A recent study, published July 16, 2020, in the AHA’s journal Stroke, examined 30,000+ American adults over a period of ten years. The study, called “Reasons for Geographic and Racial Differences in Stroke” (REGARDS), found seven of the ten tracked social determinants of health (SDOH) to be associated with stroke. The seven were race, education, income, zip code poverty, health insurance, social isolation, and residence in one of the ten lowest-ranked states for public health infrastructure. 

The study further found that each SDOH was independently associated with a higher risk of stroke under the age of 75 and that the risk of stroke rose as the number of SDOH increased. Interestingly, the SDOH did not show a statistically significant effect for individuals 75 or over as compared to the control group (people who did not have those SDOH). 

The study concluded that targeting people with multiple SDOH could help reduce the risk of stroke in these vulnerable populations. 

Specific findings of the REGARDS study

REGARDS followed 30,239 Black and white adults (40.4% black, 55.4% women) across 48 states and DC for nearly 10 years. They were recruited from 2003 to 2007, with over-sampling in the area known as the “Stroke Buckle" and the “Stroke Belt” (North Carolina, South Carolina, Georgia, Tennessee, Mississippi, Alabama, Louisiana, and Arkansas). Over a median follow-up of 9.5 years, the researchers observed 1470 strokes. Their findings include: 

• The incidence of stroke is higher in Blacks than in whites

• People with three or more SDOH were nearly two and one-half times more likely to have a stroke than those without SDOH

• Known risk factors such as hypertension, diabetes, cigarette smoking, and a history of heart issues only accounted for half of the excess stroke risk

• Stroke risk is 50% higher among individuals with three or more SDOH, even after adjusting for other known risk factors

• Black women were more likely to have a higher number of SDOH

• People who live in the southeast of the United States have a higher risk of stroke, due to poorer diet and poorer healthcare and safety net systems. 

The study found clear treatment disparity. For instance, only 45% of those with four or more SDOH were taking statins, as compared with 65% of those who did not have SDOH. The study further reinforces the need for health experts to focus on populations in which SDOH are contributing to increased cardiovascular disease, particularly stroke. 

Not only is education needed in order to help people better understand health factors and how to reverse these factors, a greater healthcare presence is also critically needed in certain high-risk populations.

Strokes are the #1 cause of long-term disability in the U.S. At Neuralert, we partner with medical personnel to help end the devastation caused by delayed treatment of stroke with our Neuralert stroke detection wristband. This non-invasive wristband technology combined with a state-of-the-art artificial intelligence algorithm can detect asymmetric arm movement to quickly signal health professionals that a stroke may be occurring, with virtually zero false alarms. Faster intervention is associated with better outcomes and lower morbidity and mortality. Contact us to find out more about Neuralert’s innovative stroke monitor.