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Title: Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites.
Austin Authors: Howard, Virginia J;McClure, Leslie A;Kleindorfer, Dawn O;Cunningham, Solveig A;Thrift, Amanda G;Diez Roux, Ana V;Howard, George
Affiliation: The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Hubert Department of Global Health and Department of Sociology, Emory University, Atlanta, GA
Epidemiology & Prevention Division, Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
Department of Neurology, University of Cincinnati College of Medicine, OH
Issue Date: 29-Nov-2016
Date: 2016-10-14
Publication information: Neurology 2016; 87(22): 2340-2347
Abstract: To assess the relationship between neighborhood socioeconomic characteristics and incident stroke in a national cohort of black and white participants. The study comprised black (n = 10,274, 41%) and white (n = 14,601) stroke-free participants, aged 45 and older, enrolled in 2003-2007 in Reasons for Geographic and Racial Differences in Stroke (REGARDS), a national population-based cohort. A neighborhood socioeconomic score (nSES) was constructed using 6 neighborhood variables. Incident stroke was defined as first occurrence of stroke over an average 7.5 (SD 3.0) years of follow-up. Proportional hazards models were used to estimate associations between nSES score and incident stroke, adjusted for demographics (age, race, sex, region), individual socioeconomic status (SES) (education, household income), and other risk factors for stroke. After adjustment for demographics, compared to the highest nSES quartile, stroke incidence increased with each decreasing nSES quartile. The hazard ratio (95% confidence interval) ranged from 1.28 (1.05-1.56) in quartile 3 to 1.38 (1.13-1.68) in quartile 2 to 1.56 (1.26-1.92) in quartile 1 (p < 0.0001 for linear trend). After adjustment for individual SES, the trend remained marginally significant (p = 0.085). Although there was no evidence of a differential effect by race or sex, adjustment for stroke risk factors attenuated the association between nSES and stroke in both black and white participants, with greater attenuation in black participants. Risk of incident stroke increased with decreasing nSES but the effect of nSES is attenuated through individual SES and stroke risk factors. The effect of neighborhood socioeconomic characteristics that contribute to increased stroke risk is similar in black and white participants.
DOI: 10.1212/WNL.0000000000003299
ORCID: 0000-0001-8533-4170
Journal: Neurology
PubMed URL: 27742815
Type: Journal Article
Appears in Collections:Journal articles

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