Cardiovascular
Association Between State-Level Policies and Stroke Mortality Kerri S Ivey* Kerri Ivey Gidarell Bryant Elizabeth Heitman Caroline Compretta Benjamin H Walker
Introduction: Despite the status of stroke as a top cause of death in the United States, notable state-level variations in stroke mortality are not well understood. Our study examines the impact of state policy, sociodemographic composition, and access to care on US stroke mortality from 2000-2019.
Methods: We merged annual state-level stroke mortality rates (per 100,000) from the National Center for Health Statistics from 2000 to 2019 with annual data on state-level policy variables. State policy variables included minimum wage, earned income tax credit, total number of economic and labor preemption laws, maximum monthly allotment of Food Stamp/SNAP benefits for 2-person family, an index of Medicaid generosity (including income eligibility, administrative burden, immigrant benefits, and Medicaid benefits), paid sick leave policies, tobacco tax, beer and wine tax, and total number of opioid-related laws. A linear fixed-effects regression was used to examine the association between state-level policies and stroke mortality.
Results: Our preliminary results show that increases in the following variables were associated with reductions in stroke mortality: state tobacco taxes (B = -3.13; 95% CI = -4.59, -1.67), total number of opioid-related laws (B = -1.28; 95% CI = -1.86, -.70), maximum monthly allotment of Food Stamp/SNAP benefits (B = -0.11; 95% CI = -0.14, -0.08), Medicaid generosity (B = -0.19; 95% CI = -0.37, -0.01), and the total number of economic and labor pre-emption laws (B = -1.24; 95% CI = -1.82, -0.67).
Conclusion: These results suggest the state-level policy context is associated with stroke mortality rates which underscores the potential for upstream economic and health policies to address geographic differences in stroke mortality. Additional analyses will explore the role of state sociodemographics and access to care variables to better understand these associations.