Medical Student Carle Illinois College of Medicine, Minnesota, United States
Introduction: Each year, 800,000 people have strokes in the United States, of which 75% are new strokes. The prevention of ischemic and hemorrhagic strokes is a priority among policymakers. While countless studies have identified comorbidities and risk factors that influence stroke, few studies investigate the geospatial association of these risk factors and their contribution to the regional prevalence of stroke. We sought to perform a comprehensive analysis of multiple national databases to study the geospatial parameters that influence stroke occurrence to better direct policymakers on where to focus education and health efforts.
Methods: We merged the Medicare Healthcare Utilization Data and the National Center for Health Statistics Disease Prevalence Database from the years 2015-2020 across 3105 US counties. Utilizing Moran’s clustering, we identified regional hotspots for average annual stroke prevalence and change in stroke rates. We utilized a geospatially weighted logistic regression with recursive feature elimination to identify predictive risk factors influencing prevalence and change.
Results: From 3105 counties, we identified 648 counties as regional hotspots, primarily covering the South Atlantic and South Central regions, and 516 counties as regional coldspots, dominantly in Mountain and Pacific regions. Hotspots for increasing stroke rates were in Florida, Kansas, Louisiana and Georgia, and Minnesota. On multivariate analysis of prevalence, hotspots were influenced by several factors, including the percent of African American populations in regions (p < 0.001), high school diploma rates (p < 0.001), and comorbidity prevalence such as hypertension (p < 0.001) and ischemic heart disease (p < 0.001). Poverty (p = 0.018), and college degrees were further predictive of changes in regional stroke rates.
Conclusion : We demonstrate regional predictors of stroke hotspots and coldspots in the United States. Our analysis provides actional information to policymakers about regional areas where targeted efforts should be focused in the United States.
