Increasing risk of stroke with increased climate vulnerability: assessing stroke burden and access to health care according to the Climate Vulnerability Index in the United States

Background:Climate change-related worsening air quality and temperature extremes are linked to increased incidence of stroke.Stroke disproportionately impacts people living with higher risk of climate-related exposures and adverse health outcomes.This is an ecological study to examine the association between stroke, climate-related risks, and distance to comprehensive stroke centers (CSC) using the U.S. Climate Vulnerability Index (CVI). Methods:CDC PLACES data was used to obtain stroke prevalence rates for 73,057 census tracts.CVI was used as measure of climate vulnerability.Maps and linear regression analyses evaluated the association between CVI score and stroke prevalence, and CVI score and distance to CSCs.Data were further stratified by CVI subdomains, regions, and historically-redlined communities. Results:As CVI score increased, the odds of stroke also increased (OR 1.11, 95% CI 1.10 -1.11).The Southeast and Midwest regions had the highest odds of stroke (OR 1.14).The social-economic, infrastructure, and baseline health CVI subdomains were the most important factors in determining stroke risk.Additionally, census tracts with the highest CVI score were 2.67 times farther away from a CSC than those census tracts in the 50 th percentile.In our analysis of metropolitan Atlanta, neighborhoods subjected to historical redlining clearly overlapped with high CVI-stroke prevalence census tracts. Conclusions:Increased CVI score was associated with increased stroke burden and farther CSC distance.The most important contributing factors the social-economic, health, and infrastructure subdomains, highlighting the need to address these underlying conditions and improve health resources as the worsening climate crisis threatens to exacerbate disparities in already at-risk populations. Key MessageWhat is already known on this topic -Stroke is a climate-sensitive disease.Climate change related stroke deaths are increasing disproportionately in populations who are already at higher disease risk, including people from racial and ethnic minority groups, older adults, and communities with lower socioeconomic status (SES) What this study adds -This is the first reported assessment of the recently published nationwide climate vulnerability index to identify associations between a community's stroke burden and key drivers in their overall climate vulnerability.How this study might affect research, practice or policy -This study has broad implications for how to identify populations who would most benefit from targeted interventions to address underlying disparities that enhance risk of climate-sensitive diseases such as stroke.