---
title: "Current immunosuppressive treatment and self-reported lifetime stroke history in US adults"
id: "plos-one-4-current-immunosuppressive-treatment-and-self-reported-lifetime-stroke-history"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-4-current-immunosuppressive-treatment-and-self-reported-lifetime-stroke-history"
content_type: "clinical_feed_article"
specialty: "Neurology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164"
published_at: "2026-07-30T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Current immunosuppressive treatment and self-reported lifetime stroke history in US adults
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-4-current-immunosuppressive-treatment-and-self-reported-lifetime-stroke-history
- **Specialty:** [Neurology](https://medichelpline.com/clinical-feed/neurology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164)
- **Published At:** 2026-07-30T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This nationally representative cross-sectional analysis pooled 2023–2024 National Health Interview Survey (NHIS) Adult Sample data to assess whether current self-reported **immunosuppressive treatment** is associated with self-reported lifetime **stroke** history among US adults. - The analytic complete-case sample included 60,026 adults (weighted to ~250 million US adults). The weighted prevalence of current immunosuppressive treatment was 4.6%. - Stroke history was more common in adults reporting immunosuppressive treatment (6.0%) than those not reporting treatment (2.8%). - Unadjusted survey-weighted logistic regression showed higher odds of stroke history with immunosuppressive treatment (OR 2.24, 95% CI 1.86–2.70). Sequential adjustment for demographics and cardiometabolic factors attenuated but did not eliminate the association. - In the fully adjusted model (age, sex, race/ethnicity, hypertension, diabetes, smoking, coronary heart disease, income-to-poverty), the association persisted (adjusted OR 1.71, 95% CI 1.40–2.08, p 55 years (OR 1.35) and possible effect modification by race/ethnicity; no interaction by sex, diabetes, or hypertension was observed. These subgroup results were exploratory and not corrected for multiple comparisons. - Sensitivity analyses using a three-level exposure (definite, uncertain, none) produced consistent results; uncertain responders also showed higher odds of stroke history. - Limitations include cross-sectional design, broad exposure definition lacking medication class/dose/indication, self-reported stroke without physician confirmation or subtype, potential confounding by indication, and omission of some stroke risk factors (e.g., atrial fibrillation, physical activity) from primary models. - Authors conclude current immunosuppressive treatment status likely marks a medically complex population with higher cerebrovascular disease burden; findings are associative and not causal.
## Clinical Analysis & Structured Key Points
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Current immunosuppressive treatment and self-reported lifetime stroke history among United States adults: A cross-sectional study * Muhammad Saad Ansari, Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing Affiliation Neurology, Punjab Medical College, Faisalabad, Pakistan ⨯ * Fiza Nisar, Roles Conceptualization, Data curation, Investigation, Methodology, Writing – original draft, Writing – review & editing Affiliation Neurology, Punjab Medical College, Faisalabad, Pakistan ⨯ * Ufaq Reyaz, Roles Data curation, Supervision, Writing – original draft, Writing – review & editing Affiliation Neurology, Punjab Medical College, Faisalabad, Pakistan ⨯ * Mahnoor Fatima, Roles Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing Affiliation Neurology, Punjab Medical College, Faisalabad, Pakistan ⨯ * Umair Ahmad Khan, Roles Methodology, Project administration, Supervision, Visualization, Writing – original draft, Writing – review & editing Affiliation Neurology, Louisiana State University, Shreveport, United States of America [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0007-4032-3989 ](https://orcid.org/0009-0007-4032-3989 "ORCID Registry") ⨯ * Baseerullah Hadi , Roles Conceptualization, Data curation, Formal analysis, Supervision, Writing – original draft, Writing – review & editing * E-mail: Hadibaseerullah@gmail.com Affiliation Faculty of Medicine, Rokhan Institute of Higher Education, Jalalabad, Afghanistan [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0009-0004-1682-0641 ](https://orcid.org/0009-0004-1682-0641 "ORCID Registry") ⨯ * Muhammad Talha Khalid Roles Investigation, Methodology, Project administration, Writing – original draft, Writing – review & editing Affiliation Internal Medicine, Allied Hospital, Faisalabad, Pakistan ⨯ # Current immunosuppressive treatment and self-reported lifetime stroke history among United States adults: A cross-sectional study * Muhammad Saad Ansari, * Fiza Nisar, * Ufaq Reyaz, * Mahnoor Fatima, * Umair Ahmad Khan, * Baseerullah Hadi, * Muhammad Talha Khalid ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: July 30, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0355164) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0355164) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0355164) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0355164) * [Peer Review](https://journals.plos.org/plosone/article/peerReview?id=10.1371/journal.pone.0355164) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#abstract0) * [Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#sec001) * [Materials and methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#sec002) * [Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#sec009) * [Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#sec015) * [Conclusions](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#sec020) * [Supporting information](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#sec021) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0355164) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164) ## Abstract Current immunosuppressive treatment is used for autoimmune, inflammatory, malignant, transplant-related, and other chronic conditions that may carry elevated cerebrovascular burden. Nationally representative evidence on current immunosuppressive treatment status and self-reported lifetime stroke history remains limited. This cross-sectional study used pooled 2023–2024 National Health Interview Survey Adult Sample data. The analytic sample included adults aged 18 years or older with valid survey weights and complete data on exposure, outcome, and selected covariates. The exposure was current self-reported use of medications that weaken the immune system. The outcome was self-reported lifetime stroke history. Survey-weighted logistic regression estimated odds ratios and 95% confidence intervals, accounting for National Health Interview Survey stratification, clustering, and adjusted sampling weights. The final analytic sample included 60,026 adults, representing approximately 250 million United States adults. The weighted prevalence of current immunosuppressive treatment was 4.6%. Stroke history was more common among adults receiving immunosuppressive treatment than among those not receiving treatment (6.0% versus 2.8%). In unadjusted analysis, immunosuppressive treatment was associated with higher odds of stroke history (odds ratio 2.24, 95% confidence interval 1.86–2.70, p < 0.001). After full adjustment for age, sex, race/ethnicity, hypertension, diabetes, smoking status, coronary heart disease, and income-to-poverty category, the association persisted (adjusted odds ratio 1.71, 95% confidence interval 1.40–2.08, p < 0.001). Current immunosuppressive treatment status, likely reflecting both medication exposure and underlying disease burden, was associated with higher odds of self-reported lifetime stroke history among United States adults. Because of the cross-sectional design, broad exposure definition, self-reported outcome, and potential confounding by indication, these findings should be interpreted as an association rather than evidence of causation. ## Figures ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.t003) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.t004) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.t002) ![Table 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.t003) ![Table 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.t004) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.g001) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.t001) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.t002) **Citation:** Ansari MS, Nisar F, Reyaz U, Fatima M, Khan UA, Hadi B, et al. (2026) Current immunosuppressive treatment and self-reported lifetime stroke history among United States adults: A cross-sectional study. PLoS One 21(7): e0355164. https://doi.org/10.1371/journal.pone.0355164 **Editor:** Marwan Salih Al-Nimer, University of Diyala College of Medicine, IRAQ **Received:** June 10, 2026; **Accepted:** July 18, 2026; **Published:** July 30, 2026 **Copyright:** © 2026 Ansari et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** The datasets analysed during the current study are publicly available from the National Center for Health Statistics National Health Interview Survey repository: [https://www.cdc.gov/nchs/nhis/⁠](https://www.cdc.gov/nchs/nhis/%E2%81%A0). The 2023 and 2024 Adult Sample public-use data files and documentation were used for this analysis. **Funding:** The author(s) received no specific funding for this work. **Competing interests:** The authors have declared that no competing interests exist. ## Introduction Stroke is a major cause of morbidity, disability, and mortality in the United States and remains a central focus of cardiovascular and neurologic prevention efforts [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref001)]. Identifying populations with elevated cerebrovascular disease burden is important for risk-factor recognition and public health surveillance. Adults receiving immunosuppressive treatment may represent one such population. Immunosuppressive medications are used for heterogeneous indications, including systemic autoimmune disease, inflammatory disorders, malignancy-associated treatment, and transplant-related care. These indications frequently overlap with chronic inflammation, immune dysregulation, high comorbidity burden, and intensive health-care utilization, processes that have independently been linked to cerebrovascular risk [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref002),[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref004)]. Nationally representative studies therefore need to distinguish carefully between medication exposure and the underlying disease burden that leads to treatment. The biologic plausibility linking immune-mediated disease and cerebrovascular disease is supported by literature on inflammation, atherosclerosis, and immune dysregulation [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref002)–[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref005)]. Large population-based evidence has also shown that autoimmune diseases are associated with increased risk across multiple cardiovascular outcomes, including cerebrovascular disease [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref006)]. Disease-specific literature has reported elevated cardiovascular or cerebrovascular risk in rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel disease [[7](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref007)–[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref010)]. Medication-specific observational studies in autoimmune populations suggest that cardiovascular risk may differ by drug class, disease severity, and treatment indication [[11](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref011)–[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref014)]. Despite this background, nationally representative United States evidence on the association between current immunosuppressive treatment status and self-reported lifetime stroke history is limited. This study used pooled 2023–2024 National Health Interview Survey Adult Sample data to examine whether current self-reported immunosuppressive treatment was associated with self-reported lifetime stroke history among United States adults. We hypothesized that adults reporting current immunosuppressive treatment would have higher odds of reporting prior stroke after adjustment for demographic, socioeconomic, behavioral, and cardiometabolic factors. Because the National Health Interview Survey ascertains stroke history through a single self-reported item without physician confirmation or subtype classification, “stroke” in this study refers broadly to any self-reported lifetime cerebrovascular event and does not distinguish ischemic from hemorrhagic subtype. ## Materials and methods ### Study design and data source This cross-sectional study used pooled 2023–2024 National Health Interview Survey Adult Sample data. The National Health Interview Survey is a nationally representative, stratified, multistage probability survey of the civilian, noninstitutionalized United States population conducted by the National Center for Health Statistics [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref015)]. National Health Interview Survey sampling weights, strata, and primary sampling units are designed to support population-representative estimation and valid variance estimation when the complex survey design is incorporated [[15](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref015)]. The Strengthening the Reporting of Observational Studies in Epidemiology guidance was used to structure reporting [[16](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone.0355164.ref016)]. The 2023 and 2024 public-use data files were accessed for research purposes on 31 May 2026. The authors accessed only de-identified public-use data and had no access to information that could identify individual participants during or after data collection. ### Study population The study population included adults aged 18 years or older. Participants were eligible if they had valid information on immunosuppressive treatment status and self-reported lifetime stroke history, a positive adult sample weight, and complete data for selected covariates. Survey weights were divided by two to account for pooling two survey years. The final complete-case analytic sample included 60,026 adults. A complete-case analysis was used because the primary regression models required nonmissing data for exposure, outcome, survey design variables, and all selected covariates. Of 62,034 eligible adults, 2,008 were excluded because of missing covariate data, leaving a final analytic sample of 60,026 adults. This represented approximately 3.2% of the eligible sample. Complete-case analysis was considered acceptable because the proportion excluded was small; however, possible selection bias from missing data was acknowledged as a limitation. [Fig 1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0355164#pone-0355164-g001) summarizes sample selection. [![thumbnail](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0355164.g001)](https://journals.plos.org/plosone/article/figure/image?size=medium&id=10.1371/journal.pone.0355164.g001 "Click for larger image") Download: * [PNG larger image](https://journals.plos.org/plosone/article/figure/image?download&size=large&id=10.1371/journal.pone.0355164.g001) * [TIFF original image](https://journals.plos.org/plosone/article/figure/image?download&size=original&id=10.1371/journal.pone.0355164.g001) Fig 1. Flow diagram of analytic sample selection from pooled 2023–2024 National Health Interview Survey Adult Sample data. NHIS, National Health Interview Survey. [ https://doi.org/10.1371/journal.pone.0355164.g001](https://doi.org/10.1371/journal.pone.0355164.g001) ### Exposure The exposure was current self-reported immunosuppressive treatment status, based on the National Health Interview Survey item regarding current use of medications that weaken the immune system (MEDRXTRT_A). The primary exposure was coded as yes versus no. The National Health Interview Survey immunosuppressive treatment item does not capture medication class, dose, treatment indication, or disease severity; therefore, medication-specific or indication-specific associations with stroke could not be examined, and the exposure should be interpreted as a broad marker of immunosuppressive treatment status rather than a specific therapeutic agent. Refused or “don’t know” responses for current immunosuppressive treatment were uncommon, occurring in 186 of 62,034 eligible participants (0.30%; refused: n = 36; don’t know: n = 150). These responses were grouped with the no-treatment category in the primary binary analysis to preserve a conservative reference group and avoid unstable estimates from sparse categories; a sensitivity analysis modeled uncertain responses separately to evaluate whether this coding decision affected the findings. ### Outcome The primary outcome was self-reported lifetime stroke history, defined using STREV_A. Participants reporting a prior stroke were classified as having stroke history. The analysis estimates the association between current treatment status and lifetime stroke history, not incident stroke or prospective stroke risk. ### Covariates Covariates were selected a priori based on known or suspected associations with both immunosuppressive treatment status and stroke history, and because they are consistently ascertained and validated within the National Health Interview Survey Adult Sample core module. These included age, sex, race/ethnicity, hypertension, type 2 diabetes, smoking status, coronary heart disease, and income-to-poverty category. Other established stroke-related factors, including body mass index, hyperlipidemia, physical activity level, atrial fibrillation, and chronic kidney disease, were not included in the primary adjustment set; their omission is addressed as a source of potential residual confounding in the Limitations. Race/ethnicity was categorized as non-Hispanic White, non-Hispanic Black, Hispanic, or Other. Smoking status was categorized as never smoker, current every day
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