Social determinants of health and blood pressure control after intracerebral hemorrhage
1
1 Brain Care Labs, Mass General Brigham, Boston, United States
2
2 Department of Neurology, Mass General Brigham, Boston, United States
3
3 Broad Institute of MIT and Harvard, Cambridge, United States
4
4 Center for Genomic Medicine, Mass General Brigham, Boston, United States
5
5 Department of Physical Medicine and Rehabilitation, Mass General Brigham, Boston, United States
6
6 Department of Neurology, Los Angeles General Medical Center, Los Angeles, United States
7
7 Department of Neurology, Yale School of Medicine, New Haven, United States
8
8 Department of Neurology, McGovern Medical School, The University of Texas Health Science Center, Houston, United States
9
9 R. Adams Cowley Shock Trauma Center, Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, United States
10
10 Neuroscience Institute, The Queen's Medical Center, Honolulu, United States
11
11 Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, United States
12
12 Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, United States
13
13 Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, United States
Popul. Med. 2026;8(Supplement Supplement 1):A1370
ABSTRACT
INTRODUCTION:
Blood pressure (BP) control is the most potent modifiable risk factor for secondary events after spontaneous, non-traumatic intracerebral hemorrhage (ICH) (1–3), yet fewer than half of ICH survivors achieve BP control three months post-ICH (4). We hypothesize that adverse social determinants of health (SDOH) contribute to poor BP control after ICH.
METHODS:
ICH survivors were prospectively enrolled across eight medical centers in the United States. Participants completed home BP measurements and telephone follow-up every three months post-ICH. We selected five SDOH reflecting the Healthy People 2030 SDOH domains and dichotomized them to reflect disadvantaged levels: education, employment, social support, insurance, and social deprivation index (SDI). We tested each SDOH for its association with uncontrolled BP (≥130/80 mmHg) using logistic regression models adjusted for age, sex, and time from ICH. We then constructed a composite SDOH score based on the count of adverse SDOH and tested the composite score for its association with uncontrolled BP.
RESULTS:
We included 167 ICH survivors (mean age: 60 years, 37% female, 56% white), of whom 92 (55%) had uncontrolled BP at follow-up (median [IQR]: 92 [90-105] days). Evaluated separately, unemployment (OR: 2.62 [95% CI: 1.13-6.08]; p=0.03), high SDI (OR: 2.56 [95% CI: 1.28-5.13]; p=0.008), and absence of private insurance (OR: 2.29 [95% CI: 1.19-4.42]; p=0.013) were associated with uncontrolled BP. In the composite SDOH score, each standard deviation increase was associated with 94% greater odds of uncontrolled BP (OR: 1.94 [95% CI: 1.34-2.82]; p<0.001).
CONCLUSIONS:
In this prospective cohort of ICH survivors, SDOH were associated with uncontrolled BP three months post-ICH. These findings highlight that ICH survivors with adverse social risk profiles may benefit from tailored secondary prevention strategies to improve blood pressure control and clinical outcomes.
Blood pressure (BP) control is the most potent modifiable risk factor for secondary events after spontaneous, non-traumatic intracerebral hemorrhage (ICH) (1–3), yet fewer than half of ICH survivors achieve BP control three months post-ICH (4). We hypothesize that adverse social determinants of health (SDOH) contribute to poor BP control after ICH.
METHODS:
ICH survivors were prospectively enrolled across eight medical centers in the United States. Participants completed home BP measurements and telephone follow-up every three months post-ICH. We selected five SDOH reflecting the Healthy People 2030 SDOH domains and dichotomized them to reflect disadvantaged levels: education, employment, social support, insurance, and social deprivation index (SDI). We tested each SDOH for its association with uncontrolled BP (≥130/80 mmHg) using logistic regression models adjusted for age, sex, and time from ICH. We then constructed a composite SDOH score based on the count of adverse SDOH and tested the composite score for its association with uncontrolled BP.
RESULTS:
We included 167 ICH survivors (mean age: 60 years, 37% female, 56% white), of whom 92 (55%) had uncontrolled BP at follow-up (median [IQR]: 92 [90-105] days). Evaluated separately, unemployment (OR: 2.62 [95% CI: 1.13-6.08]; p=0.03), high SDI (OR: 2.56 [95% CI: 1.28-5.13]; p=0.008), and absence of private insurance (OR: 2.29 [95% CI: 1.19-4.42]; p=0.013) were associated with uncontrolled BP. In the composite SDOH score, each standard deviation increase was associated with 94% greater odds of uncontrolled BP (OR: 1.94 [95% CI: 1.34-2.82]; p<0.001).
CONCLUSIONS:
In this prospective cohort of ICH survivors, SDOH were associated with uncontrolled BP three months post-ICH. These findings highlight that ICH survivors with adverse social risk profiles may benefit from tailored secondary prevention strategies to improve blood pressure control and clinical outcomes.
| eISSN: | 2654-1459 |
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