The intersection of race/ethnicity, sex, and education accounted for 66% of variance in stroke incidence, with non-Hispanic White males with HS education having 1.56 times higher rates than average.
Observational (n=3,401)
How does the intersection of race/ethnicity, sex, and educational attainment influence stroke risk in a population-based cohort?
Stroke disparities are significantly shaped by the intersection of multiple social identities (race/ethnicity, sex, and education), suggesting that interventions targeting a single dimension may be insufficient.
Effect estimate: Rate ratio 1.56 (95% CI 1.30-1.88)
Abstract Background and aims Disparities in stroke risk by race/ethnicity, sex, and socioeconomic status are well documented; however, most prior research has examined these factors independently rather than jointly. Our objective was to assess how the intersection of race/ethnicity, sex, and educational attainment influences stroke risk. Methods First-ever ischemic strokes (n=3,401) were identified from a population-based study conducted in south Texas, USA (2012–2019, 2021–2023). Demographic characteristics and education (high school HS, HS, HS) were collected and imputed when missing. Negative binomial models were fit both unadjusted and adjusted for age, incorporating random effects for each intersectional subgroup (defined by race/ethnicity, sex, education) and an offset for log-transformed population counts. Random effects were pooled, and intraclass correlation coefficients (ICCs) calculated to quantify between-group variation. Results Median age (IQR) was 68 years (59–78); 57% were Mexican American, and 40% had HS education. In unadjusted analyses, between-group variation accounted for 66% of variance in stroke incidence. For example, non-Hispanic White males with a HS education had incidence rates 1.56 times higher than the across-group average (99%CI: 1.30–1.88), whereas Mexican American females with HS education had rates 0.61 times the across-group average (99%CI: 0.51–0.72). In age-adjusted analyses, between-group variation and relative rates across intersectional subgroups were attenuated but remained evident (see figures). Conclusions Findings suggest that efforts to reduce stroke disparities targeting a single dimension—such as race/ethnicity alone—may be insufficient, as disparities are shaped by the intersection of multiple social identities. Conflict of interest Lisabeth LD: nothing to disclose, author receives support from the National Institutes of Health; Kwicklis M: nothing to disclose; Shi X: nothing to disclose; Becker C: nothing to disclose; Morgenstern: nothing to disclose, author receives support from the National Institutes of Health Figure 1 - belongs to Results
Lisabeth et al. (Fri,) conducted a observational in Ischemic stroke (n=3,401). Intersection of race/ethnicity, sex, and educational attainment vs. Across-group average was evaluated on Stroke incidence (Rate ratio 1.56, 95% CI 1.30-1.88). The intersection of race/ethnicity, sex, and education accounted for 66% of variance in stroke incidence, with non-Hispanic White males with HS education having 1.56 times higher rates than average.