Survivors of Stroke Face Greater Social Risks Than Adults Who Have Not Had a Stroke: Results From a Nationwide Study.

BACKGROUND

Integrating social and medical care is one strategy to promote health equity. Yet, little is known about the prevalence of health-related social risks (social risks) among survivors of stroke. We sought to determine the prevalence of social risks among survivors and to quantify how social risks change after a stroke.

METHODS AND RESULTS

We conducted a cross-sectional analysis of community-dwelling older adults (age≥65) from the National Health and Aging Trends Survey. Six core social risks were examined: medical financial risks, utility financial risks, housing, nutrition, social isolation, and transportation. We used a Poisson regression model to explore the association of social risks and history of stroke, accounting for sociodemographic factors (age, sex, race or ethnicity, education, income, rurality) and comorbidities. In a separate series analysis, we determined the association between stroke and changes in social risks in a propensity-matched cohort. Of 5834 older adults, 673 were survivors of stroke. In cross-sectional analysis, survivors of stroke were more likely to report social risks than older adults without a history of stroke (54.3% versus 40.2%, <0.01). The largest difference between survivors of stroke and older adults who have not had a stroke was transportation disadvantage (9.7 versus 4.0, <0.01). After adjustment, a history of stroke was not associated with social risks (incidence rate ratio, 1.1 [95% CI, 0.9-1.2], =0.37). In the series analysis, there was no change in the average number of social risks after the stroke among those who had a stroke (incidence rate ratio, 1 [95% CI, 0.9-1.2], =0.78). After a stroke, social risks were stable in 66.3%, increased in 19.4%, and decreased in 14.3% of stroke survivors.

CONCLUSIONS

Over half of older adults who have had a stroke report experiencing a social risk, with a 35% higher prevalence compared with older adults who have not had a stroke. Thus, social risks disproportionately affect survivors of stroke.