BACKGROUND AND PURPOSE: Neighborhood characteristics may influence the risk of stroke and contribute to socioeconomic disparities in stroke incidence. The objectives of this study were to examine the relationship between neighborhood socioeconomic status and incident ischemic stroke and examine potential mediators of these associations. METHODS: We analyzed data from 3834 whites and 785 blacks enrolled in the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ages≥65 years from 4 US counties. The primary outcome was adjudicated incident ischemic stroke. Neighborhood socioeconomic status was measured using a composite of 6 census tract variables. Race-stratified multilevel Cox proportional hazard models were constructed adjusted for sociodemographic, behavioral, and biological risk factors. RESULTS: Among whites, in models adjusted for sociodemographic characteristics, stroke hazard was significantly higher among residents of neighborhoods in the lowest compared with the highest neighborhood socioeconomic status quartile (hazard ratio, 1.32; 95% CI, 1.01-1.72) with greater attenuation of the hazard ratio after adjustment for biological risk factors (hazard ratio, 1.16; 0.88-1.52) than for behavioral risk factors (hazard ratio, 1.30; 0.99-1.70). Among blacks, we found no significant associations between neighborhood socioeconomic status and ischemic stroke. CONCLUSIONS: Higher risk of incident ischemic stroke was observed in the most disadvantaged neighborhoods among whites, but not among blacks. The relationship between neighborhood socioeconomic status and stroke among whites appears to be mediated more strongly by biological than behavioral risk factors.
BACKGROUND AND PURPOSE: Neighborhood characteristics may influence the risk of stroke and contribute to socioeconomic disparities in stroke incidence. The objectives of this study were to examine the relationship between neighborhood socioeconomic status and incident ischemic stroke and examine potential mediators of these associations. METHODS: We analyzed data from 3834 whites and 785 blacks enrolled in the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ages≥65 years from 4 US counties. The primary outcome was adjudicated incident ischemic stroke. Neighborhood socioeconomic status was measured using a composite of 6 census tract variables. Race-stratified multilevel Cox proportional hazard models were constructed adjusted for sociodemographic, behavioral, and biological risk factors. RESULTS: Among whites, in models adjusted for sociodemographic characteristics, stroke hazard was significantly higher among residents of neighborhoods in the lowest compared with the highest neighborhood socioeconomic status quartile (hazard ratio, 1.32; 95% CI, 1.01-1.72) with greater attenuation of the hazard ratio after adjustment for biological risk factors (hazard ratio, 1.16; 0.88-1.52) than for behavioral risk factors (hazard ratio, 1.30; 0.99-1.70). Among blacks, we found no significant associations between neighborhood socioeconomic status and ischemic stroke. CONCLUSIONS: Higher risk of incident ischemic stroke was observed in the most disadvantaged neighborhoods among whites, but not among blacks. The relationship between neighborhood socioeconomic status and stroke among whites appears to be mediated more strongly by biological than behavioral risk factors.
Authors: Cari Jo Clark; Hongfei Guo; Scott Lunos; Neelum T Aggarwal; Todd Beck; Denis A Evans; Carlos Mendes de Leon; Susan A Everson-Rose Journal: Stroke Date: 2011-04-14 Impact factor: 7.914
Authors: A V Diez Roux; S S Merkin; D Arnett; L Chambless; M Massing; F J Nieto; P Sorlie; M Szklo; H A Tyroler; R L Watson Journal: N Engl J Med Date: 2001-07-12 Impact factor: 91.245
Authors: Amy H Auchincloss; Ana V Diez Roux; Mahasin S Mujahid; Mingwu Shen; Alain G Bertoni; Mercedes R Carnethon Journal: Arch Intern Med Date: 2009-10-12
Authors: Wayne Rosamond; Katherine Flegal; Karen Furie; Alan Go; Kurt Greenlund; Nancy Haase; Susan M Hailpern; Michael Ho; Virginia Howard; Brett Kissela; Bret Kissela; Steven Kittner; Donald Lloyd-Jones; Mary McDermott; James Meigs; Claudia Moy; Graham Nichol; Christopher O'Donnell; Veronique Roger; Paul Sorlie; Julia Steinberger; Thomas Thom; Matt Wilson; Yuling Hong Journal: Circulation Date: 2007-12-17 Impact factor: 29.690
Authors: Sharrelle Barber; DeMarc A Hickson; Xu Wang; Mario Sims; Cheryl Nelson; Ana V Diez-Roux Journal: Am J Public Health Date: 2016-10-13 Impact factor: 9.308
Authors: Tingjian Yan; José J Escarce; Li-Jung Liang; W T Longstreth; Sharon Stein Merkin; Bruce Ovbiagele; Stefanie D Vassar; Teresa Seeman; Catherine Sarkisian; Arleen F Brown Journal: Age Ageing Date: 2012-12-21 Impact factor: 10.668
Authors: Arleen F Brown; Li-Jung Liang; Stefanie D Vassar; Sharon Stein Merkin; W T Longstreth; Bruce Ovbiagele; Tingjian Yan; José J Escarce Journal: Neurology Date: 2013-01-02 Impact factor: 9.910
Authors: Andrea L Rosso; Jason D Flatt; Michelle C Carlson; Gina S Lovasi; Caterina Rosano; Arleen F Brown; Karen A Matthews; Peter J Gianaros Journal: Am J Epidemiol Date: 2016-06-02 Impact factor: 4.897
Authors: Sabriya L Linton; Hannah L F Cooper; Mary E Kelley; Conny C Karnes; Zev Ross; Mary E Wolfe; Don Des Jarlais; Salaam Semaan; Barbara Tempalski; Elizabeth DiNenno; Teresa Finlayson; Catlainn Sionean; Cyprian Wejnert; Gabriela Paz-Bailey Journal: Am J Public Health Date: 2015-10-15 Impact factor: 9.308
Authors: Jaime E Mirowsky; Robert B Devlin; David Diaz-Sanchez; Wayne Cascio; Shannon C Grabich; Carol Haynes; Colette Blach; Elizabeth R Hauser; Svati Shah; William Kraus; Kenneth Olden; Lucas Neas Journal: J Expo Sci Environ Epidemiol Date: 2016-09-21 Impact factor: 5.563
Authors: Sophia Kostelanetz; Chiara Di Gravio; Jonathan S Schildcrout; Christianne L Roumie; Douglas Conway; Sunil Kripalani Journal: Ethn Dis Date: 2021-01-21 Impact factor: 1.847