Examining Health-Related Risk Factors for Stroke and the Role of Health Insurance in Moderating Lifestyle: Evidence from the BRFSS

Stroke remains one of the leading causes of mortality and disability in the United States. However, there are still disparities in how lifestyle and healthcare access shape stroke outcomes. This study investigates the associations between smoking, alcohol consumption, body mass index (BMI), mental and physical health, sleep duration, health insurance status, and stroke incidence using data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS, N = 77,146). Logistic regression models are applied to estimate the direct effects of these factors on stroke risk, as well as the moderating role of health insurance.

The results indicate that while some traditional risk factors, such as smoking and alcohol use, show weaker or unexpected associations with stroke in this dataset, mental health, physical health, and health insurance coverage demonstrate significant protective effects. In particular, interaction analyzes reveal that health insurance strengthens the beneficial impact of better mental and physical health and adequate sleep on reducing stroke risk. These findings highlight the importance of considering access to healthcare not only as an independent determinant of health, but also as a moderator that amplifies the benefits of healthy lifestyles.

This study contributes to public health research by underscoring the complex interaction between behavioral risk factors and structural determinants such as health insurance. Policies that expand access to affordable healthcare should improve the effectiveness of lifestyle-based prevention strategies and help reduce stroke incidence among disadvantaged populations.