Date of Conferral
1-9-2025
Degree
Ph.D.
School
Public Health
Advisor
Bin Cai
Abstract
Disparities exist in stroke prevalence and outcome. There is sparsity of ecological studies at the census tract level that elucidate neighborhood predictors of stroke prevalence in states across U.S. Health and Human Services Region 3 (HHS Region 3: Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia). This study was conducted to explore the geospatial relationship 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: (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 square regression analysis was run to determine indices with the greatest predictive utility on stroke prevalence. The geographic weighted regression model showed the varying strengths of relationship between predictors and stroke prevalence across census tracts in HHS Region 3. Hot spot analysis identified census tracts with uniformly high or low stroke prevalence. The results show that affordability, education, spatial segregation, and income inequality were the strongest predictors of stroke prevalence in HHS Region 3. Widespread hot spots of stroke prevalence were seen in census tracts across West Virginia, the Appalachia region of Pennsylvania, and the south side of Virginia. Other hot spots were noted in inner cities such as Philadelphia and Baltimore. The findings of this study can inform further research, targeted investigation, and the design of quality improvement interventions in high prevalence census tracts.
Recommended Citation
Tuktur, Wanderimam R., "Geospatial Analysis of Social Variables of the Health Opportunity Index and Stroke Prevalence in Health and Human Services Region 3" (2025). Walden Dissertations and Doctoral Studies. 17165.
https://scholarworks.waldenu.edu/dissertations/17165
