- High structural racism nearly doubled stroke prevalence (4.8% vs 2.2%).
- Diabetes was almost twice as common in highest-exposure tracts (15.8% vs 7.6%).
- Obesity reached 39.5% in high-exposure neighborhoods vs 25.7% in low-exposure areas.
- Smoking (24.1% vs 11.9%) and inactivity (35.7% vs 16.7%) were markedly higher under high exposure.
- Education and income-poverty domains showed the steepest disease differentials.
- Associations remained after matching by region, demographics, access, and proximity.
- High-exposure tracts were concentrated in the South and varied by racial/ethnic composition.
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