Abstract Body: Stroke disparities are well-documented, with Black and Hispanic populations experiencing worse outcomes compared to White patients. Beyond traditional medical risk factors, social determinants of health (SDOH) and perceived racial discrimination (PRD) have been implicated in these disparities. However, the interplay between SDOH and PRD among these groups remains unclear. This study explores the relationship between SDOH and PRD among stroke survivors across racial groups. We hypothesized that PRD scores would differ across racial groups, potentially independent of the burden of SDOH.
We conducted a cross-sectional analysis of 67 stroke survivors, categorized as Black (N=38), Hispanic (N=17), or White (N=12), from an urban tertiary care center. Perceived discrimination was assessed using an adapted PhenX tool, and SDOH were evaluated using a modified PhenX survey covering five domains: education, economic stability, healthcare access, neighborhood, and social support. Statistical analyses included ANOVA and multivariable linear regression models adjusting for age, sex, stroke severity, and neighborhood disadvantage.
Significant differences in PRD were observed among racial groups (P = 0.0118). Black participants reported the highest discrimination scores (mean 10.4, SD 10.00), compared to Hispanic (mean 4.4, SD 7.01) and White participants (mean 3.3, SD 4.38). Despite this, the prevalence of ≥3 SDOH barriers was similar between Black and Hispanic participants and lower in White participants. Multivariable analysis revealed that Black individuals had significantly higher PRD scores than both Hispanic (Beta estimate -6.90, 95% CI: -12.38 to -1.42, P = 0.0144) and White individuals (Beta estimate -7.72, 95% CI: -13.43 to -1.42, P = 0.0089). No significant differences in other SDOH domains were found except for neighborhood disadvantage, which was more prevalent among Hispanic participants (P = 0.0202).
The findings reveal a dissociation between PRD and SDOH burden among stroke survivors. Black stroke survivors report higher perceived discrimination despite similar SDOH burdens as Hispanic participants. These results underscore the importance of addressing perceived discrimination independently of SDOH in interventions aimed at reducing racial disparities in stroke outcomes. Further research is needed to explore the mechanisms driving these differences and to develop targeted strategies for mitigating their impact.