ABSTRACT NUMBER: ESOC2026A2039 THE INTERSECTION OF RACE/ETHNICITY, SEX AND EDUCATION AND STROKE RISK

Abstract Background and aims Disparities in stroke risk by race/ethnicity, sex, and socioeconomic status are well documented; however, most prior research has examined these factors independently rather than jointly. Our objective was to assess how the intersection of race/ethnicity, sex, and educational attainment influences stroke risk. Methods First-ever ischemic strokes (n=3,401) were identified from a population-based study conducted in south Texas, USA (2012–2019, 2021–2023). Demographic characteristics and education (<high school [HS], HS, >HS) were collected and imputed when missing. Negative binomial models were fit both unadjusted and adjusted for age, incorporating random effects for each intersectional subgroup (defined by race/ethnicity, sex, education) and an offset for log-transformed population counts. Random effects were pooled, and intraclass correlation coefficients (ICCs) calculated to quantify between-group variation. Results Median age (IQR) was 68 years (59–78); 57% were Mexican American, and 40% had >HS education. In unadjusted analyses, between-group variation accounted for 66% of variance in stroke incidence. For example, non-Hispanic White males with a HS education had incidence rates 1.56 times higher than the across-group average (99%CI: 1.30–1.88), whereas Mexican American females with >HS education had rates 0.61 times the across-group average (99%CI: 0.51–0.72). In age-adjusted analyses, between-group variation and relative rates across intersectional subgroups were attenuated but remained evident (see figures). Conclusions Findings suggest that efforts to reduce stroke disparities targeting a single dimension—such as race/ethnicity alone—may be insufficient, as disparities are shaped by the intersection of multiple social identities. Conflict of interest Lisabeth LD: nothing to disclose, author receives support from the National Institutes of Health; Kwicklis M: nothing to disclose; Shi X: nothing to disclose; Becker C: nothing to disclose; Morgenstern: nothing to disclose, author receives support from the National Institutes of Health Figure 1 - belongs to Results