Operationalizing the Health Opportunity Index to Address Stroke Prevalence Across Census Tracts in Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia

Understanding the impact of neighborhood-level factors on stroke prevalence is crucial for addressing existing disparities. However, there is a distinct lack of ecological studies at the census tract level that investigate the social determinants of health (SDOH) influencing stroke prevalence within the U.S. Health and Human Services Region 3 (HHS Region 3: Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia). This study adopted a multivariate modeling approach to investigate the association between the 13 indicators of the Health Opportunity Index (HOI) and stroke prevalence at the census tract level in HHS Region 3 using four HOI indicator profiles and to highlight the specific SDOHs that are most associated with stroke prevalence. The four HOI indicator profiles include: (a) neighborhood and built environment profile, (b) social and community context profile, (c) resource profile, and (d) economic profile. The methodological approach was quantitative, using secondary data. The sample size was 8021 census tracts. The HOI was estimated for each census tract in the study area. Ordinary least squares regression (OLS) analysis and spatial lag model (SLM) were run to examine whether the 13 indicators of the HOI (categorized into four profiles) reliably predict stroke prevalence and to determine the most appropriate model that best identifies the strongest predictors of stroke prevalence. The results show that affordability, education, spatial segregation, and income inequality indicators were the strongest predictors of stroke prevalence in HHS Region 3. This granular research identifies the neighborhood-level SDOH most strongly linked to stroke prevalence, which can be leveraged to guide the development of targeted public health programs, quality improvement initiatives, resource allocation, and policy creation to combat stroke-related morbidity and mortality across census tracts in HHS Region 3. For example, the built environment, encompassing factors like employment access, affordable housing, and walkability, profoundly influences stroke prevalence and provides urban planners with practical insights for developing healthier, more equitable communities, such as creating neighborhood parks to encourage physical activity, a key factor in stroke prevention. This study also provides neighborhood organizations with the evidence needed to pursue grant funding and raise awareness about the socio-structural influences on stroke outcomes in their respective neighborhoods. Lastly, the insights generated from our study can facilitate collaborative decision-making processes with communities in HHS Region 3 regarding the prioritization of neighborhood-level SDOH for targeted public health interventions. This prioritization should focus on addressing predictors of stroke prevalence that are congruent with the community’s established priorities, thereby maximizing cost savings.