Date of Conferral





Public Health


Naoyo Mori


The stroke rate in Virginia is above the national rate. Stroke results in poor quality health, morbidity, and mortality. This quantitative epidemiological study was conducted to investigate whether a significant association exists between stroke and (a) socioeconomic and (b) neighborhood factors among people who were admitted to Virginia hospitals between 2010 and 2015. An ecological design, including ecosocial theory, was used to examine associations between environmental factors and stroke. Data (746 census output areas) were acquired using patients' billing zip codes from the Virginia Health Information System in combination with socioeconomic and neighborhood data by Zip Code Tabulation Area from the U.S. Census Bureau and the U.S. Food and Drug Administration. Results of linear regression analysis showed a significant association between stroke hospitalization rate and educational attainment, per capita income, and Gini coefficient for income distribution. Also, a significant association emerged between stroke and neighborhood risk factors such as food access, Walkability Index, and population density. Findings from a one-way ANOVA showed a significant geographic difference in stroke hospitalization rate with the highest stroke rate in eastern Virginia and the lowest stroke rate in northern Virginia. Results may help stakeholders, policymakers, and public health agencies design, prioritize, and implement community-based prevention programs to reduce stroke rates in Virginia.