Impact of Area Social Predictors of Health on Black-White Disparities in Stroke Mortality

This dissertation investigated the area social predictors of health (ASPoH) and Black-White disparities in stroke mortality relationship. Utilizing stroke mortality data obtained from the Florida Department of Health for years 1998-2002, and social and economic data obtained from the year 2000 Census of Population, this study examined the effect of resource availability at the census tract level on Black-White disparities in stroke mortality. The influence of social class on Black-White disparities in stroke mortality and effect modification by social class of the association between Black-White disparities and ASPoH variables was also investigated. Principal component analysis produced four ASPoH scores from economic and social measures. Multiple regression analysis assessed the predictive ability of these ASPoH variables on Black-White disparities. Increases in the female Black-White ratio were significantly associated with increases in the magnitude of the ASPoH-1 and ASPoH-2 variables. When regression analyses were restricted (in terms of population count minimums) to a subset of census tracts, increases in the ASPoH-1 and ASPoH-2 variables were significantly associated with increases in all Black-White disparity measures for both males and females. Assessment of the influence of social class on Black-White disparities in stroke mortality was only feasible at the state level due to a lack of data at the census tract level. With the exception of the 65+ years age-group, Black males and females experienced higher age-group specific stroke mortality rates across each of the social class groups. Inconsistent with previous research findings, Black residents who attained a high school degree had the highest stroke death rates compared to all other educational attainment groups. In the assessment of social class as a potential effect modifier, the study hypothesis stated that the ASPoH measures would have the greatest impact on those residents in the lowest social class category. This predicted effect was only supported when the Male Black-White ratio disparity score was examined. Study findings support the conjecture that unknown and unmeasured processes influence the association between area social predictors and stroke mortality for Black Floridians. Identification of modifiable societal characteristics may be the key to unlocking the foundation of disparities in health outcomes