Neurology
Structural Sexism and Stroke Incidence among Black and White Women and Men: Evidence from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study Chen Chen* Chen Chen Chen Chen Chen Chen Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
Background: Individual-level social factors are disproportionately associated with stroke for women. Ecosocial theory suggests that structural determinants, such as structural sexism (SS), could be a stroke risk factor for both sexes, but little empirical evidence exists.
Method: Individuals aged ≥45 years from the nationwide REGARDS study without stroke at baseline (2003-2007) were included (n=27,881) and followed for incident stroke or death until September 30, 2022. A composite measure of SS, operationalized as a sum score of inequalities between women and men across multiple social determinants of health at the county or state level, was calculated using US census and administrative data (Table 1) and linked to study participants by FIPS code of home address at baseline. Associations between SS and its subdomains with stroke among women and men, accounting for the competing risk of death and clustering of individuals within counties, were assessed by sex-stratified Fine-Gray models with robust sandwich estimators. Models were adjusted for covariates listed in Table 2. Interactions between SSs and sex were added to unstratified models.
Results: Over a median of 12.5 years of follow-up, 1,793 individuals (mean age 64.6 years, 55.5% women) had incident stroke. SS was associated with increased stroke rates (HR=1.05, 95% CI 0.97, 1.13 per one std deviation increase in SS) among women and decreased stroke rates (HR=0.92, 95% CI 0.85, 0.99) among men (interaction p-value=0.01). For subdomains of SS (Table 2), only socioeconomic inequality was associated with increased stroke rates (HR=1.14, 95% CI 1.06, 1.23) among women, and only conservative religion was associated with decreased stroke rates (HR=0.88, 95% CI 0.80, 0.97) among men.
Conclusion: Findings suggest the potentially harmful impact of SS, particularly gender inequalities in socioeconomic status, on stroke risk among women. Future studies should aim to unravel the underlying mechanisms of this association.
