Structural inequalities and incident stroke among Black and White adults
Description: Stroke is a leading cause of death and disability. While stroke incidence has declined since the late 20th century in the US, Black persons, women, and Stroke Belt residents continue to be disproportionately affected by stroke. Individual characteristics, such as socioeconomic status and traditional stroke risk factors, do not fully explain these differences. Thus, a better understanding of upstream structural factors driving stroke incidence among diverse populations is needed to eliminate these disparities. As fundamental causes of health disparities, structural racism (SR) and structural sexism (SS) have an interlocking, mutually constituted, and reinforcing influence on population health. Emerging studies have examined the impact of SR on stroke and its risk factors, but no studies have investigated the impact of SS and its joint effects with SR on stroke incidence. Thus, this study aims to understand the influence of structural inequalities (SR and SS) on stroke incidence through a unique linkage of publicly available data sources, providing sociopolitical context information across multiple domains (political, educational, economical, segregational, judicial, reproductive) of SR and SS, with participants' data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS is a national cohort study with oversampling of Black adults and Stroke Belt residents from 1,855 of 3,033 US counties. Follow-up for incident stroke is ongoing for 30,239 middle-aged and older participants recruited between 2003-2007. Using residential address history (from birth to median age of 51 years) collected at the baseline interview and the linked contextual data, I will 1) compile county-level SR and SS measures for REGARDS participants at mid-to-later life (baseline) and across the life course and 2) determine the extent to which mid-to-later life and life-course exposure to county-level SS individually (Aim 1) and jointly with SR (Aim 2) shape stroke incidence among intersectional groups defined by multiple individual identities (age, race, gender). Findings will shed light on structural drivers of stroke incidence and disparities. Findings may also inform policies that go beyond individual-level solutions to promote gender and racial equity and help reduce stroke in multiply disadvantaged groups, such as Black women. This study aligns with the AHA’s mission, research priorities, and strategic plan for improving cardiovascular health for all.
Funder: American Heart Association
Amount: $152,800
Funding type: fellowship
Funder scheme: Postdoctoral Fellowship
Start date: 2025-03-01
End date: 2027-02-28
Investigators: Chen Chen, Chen Chen
Institution: The Regents of the University of Michigan
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Funded outputs count: 1
Funder award ID: 25POST1378391
OpenAlex ID: G170792295