Quantitative and Spatial Associations of High Disability Prevalence and Extreme Heat With Stroke Disparities in...

Compared with individuals without disabilities, people with physical, sensory, intellectual, and psychological disabilities have increased stroke risk, and when exposed to extreme heat, they are more vulnerable to adverse effects, including heat-related illness, cardiovascular diseases, poststroke conditions, and mortality. The purpose of this study is to investigate the association of populations with disabilities and the colocation of extreme heat with geographic patterns of stroke mortality.

Data for community areas in Chicago were collected and analyzed in 2024-2025. Ordinary least-squares and spatial regression models were used to identify significant predictors with sociodemographics and empirical Bayes rates for stroke mortality. Spatial clustering and colocation analysis were used to identify retrospective high stroke mortality rate clusters and cluster exposure to recent extreme heat data, originating from community heat sensors.

The spatial error model performed the best in explaining stroke mortality rate, evidenced by the lowest Akaike Information Criterion and Bayesian Information Criterion values and with a spatial pseudo r²=0.60. Significant predictor variables (p<0.05), controlling for sociodemographics and income, were middle-aged disability populations (aged 40-64 years) with a positive association and non-Hispanic White and Hispanic with negative associations. A significant local cluster for high stroke mortality was found in the Chicago Southside. Roughly half of the community areas in the high stroke mortality cluster overlapped with exposure to the highest quartile of mean heat index measures (>89.54°F), which is near the 90°F threshold for extreme heat and risks of heat-related illnesses, including epidemiologic risks of stroke and cardiovascular disease.

This study identifies novel and relevant community risk factors-middle-aged population ability status and extreme heat-that have been overlooked in lowering stroke mortality. Findings suggest that measures addressing these socioenvironmental factors in public health campaigns, including Chicago's action plan for cardiovascular diseases, are needed for stroke prevention and community health.