Dissociation between Perceived Discrimination and SDOH among Black and Hispanic Stroke Patients

Social determinants of health (SDOH) barriers and perceived racial discrimination (PRD) tend to cluster in minoritized communities due to structural racism. The relationship between SDOH and PRD among Black and Hispanic stroke survivors is unclear, however. Understanding this relationship has implications for stroke disparities interventions.

To determine the prevalence of SDOH barriers and PRD and their relationship among Black and Hispanic stroke survivors.

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. We hypothesized that PRD differs across minoritized race-ethnic groups, independently of SDOH. 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.

The prevalence of ≥3 SDOH barriers was similar between Black and Hispanic participants and lower in White participants. However, Black participants reported the highest PRD 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). Multivariable analysis revealed that Black participants had significantly higher PRD scores than both Hispanic (Beta estimate=-6.90, 95% CI:=-12.38 to -1.42, P=0.0144) and White participants (Beta estimate=-7.72, 95% CI: -13.43 to -1.42, P=0.0089). No significant differences between SDOH domains were found except for neighborhood disadvantage, which was more prevalent among Hispanic participants (P=0.0202).

A significant dissociation between PRD and SDOH burden was found among minoritized stroke survivors. Black participants in our study reported the highest PRD, which was more than twice the levels of PRD observed among Hispanic participants despite a similar SDOH burden. White participants had the lowest PRD and SDOH burden. Addressing PRD independently of SDOH may be an important component of interventions designed to reduce race-ethnic disparities in stroke outcomes.