Adverse Social Factors Tied to Early-Onset Stroke

TOPLINEAdverse social determinants of health (SDOH) experienced during early to mid-adulthood — including lower household income, fewer years of education, greater neighborhood deprivation, and lack of health insurance — were each associated with increased risk for early-onset stroke or transient ischemic attack (TIA). METHODOLOGYResearchers conducted a prospective longitudinal analysis of 5114 participants (median age at baseline, 25 years; 54.5% women) enrolled in the CARDIA study between 1985 and 1986. They assessed five SDOH domains: economic stability (income, wealth, unemployment, financial strain, food insecurity, financial resilience), education access (number of years attained), healthcare access (insurance status, usual source of care, distance to care, ability to pay), neighborhood/built environment (deprivation index, environment score), and social/community context (racial discrimination, social contact, loneliness, family support).The primary outcome was incident nonfatal or fatal stroke or TIA. The median follow-up duration was 37.9 years.Researchers evaluated associations between individual and cumulative adverse SDOH and incident stroke or TIA.TAKEAWAYOverall, 146 participants (2.9%) experienced stroke; of those, 20 (13.7%) were TIAs, and all events occurred before the age of 65.Each $10,000 decrease in household income was associated with increased risk for stroke (hazard ratio [HR], 1.24; 95% CI, 1.11-1.39), while each additional year of education was associated with reduced risk for stroke (HR, 0.93; 95% CI, 0.87-0.99).Greater neighborhood deprivation was linked to higher risk for stroke (HR, 1.21; 95% CI, 1.02-1.43), as was lacking health insurance (HR, 1.49; 95% CI, 1.05-2.11).Experiencing a higher number of adverse SDOH domains was associated with progressively higher risk for stroke ( HR, 1.65; 95% CI, 0.91-2.97, for two adverse domains; and HR, 2.00; 95% CI, 1.09-3.66, for three or more adverse domains; P for trend = .005).The association between lower income and the risk for stroke appeared stronger among Black participants and women (P for interaction = .02 for both).IN PRACTICE"The findings highlight the relevance of adverse social determinants earlier in life as contributors to stroke occurring in younger adults," the authors of the study wrote.SOURCEThe study was led by Nathaniel Fleming, MD, MS, Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco. It was published online on September 4, 2026, in Stroke.LIMITATIONSMost exposures were self-reported, and the small number of stroke events forced researchers to combine stroke subtypes into one outcome, limiting power and subtype-specific conclusions. Missing data from attrition may have introduced bias. Only Black and White urban participants were enrolled, and the observational design could not establish causality.DISCLOSURESThe CARDIA study was supported by the National Heart, Lung, and Blood Institute. The present study was supported by the National Institute on Aging and National Institute of Neurological Disorders and Stroke. One author reported receiving funding from the National Institutes of Health and serving as a site subinvestigator for a clinical trial sponsored by Bayer. Another author reported being employed by the American Heart Association and receiving grants from the National Institutes of Health. Full disclosures are reported in the original article.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.