Abstract P22: Neighborhood Disadvantage and Stroke

Abstract

Background: The spatial and social separation of poorer persons and racial/ethnic minorities into disadvantaged communities may contribute to stroke disparities, but the mechanisms are not well understood. Methods: We used data from the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ≥65 years. The dependent variable was incident ischemic stroke. Residential neighborhood disadvantage was measured using a composite of six census tract variables representing income, education, employment, and wealth. Race-stratified multilevel Cox proportional hazard models were constructed, adjusted for sociodemographic characteristics (age, gender, education, and income), behavioral risk factors (smoking, physical activity, and alcohol use), and biologic risk factors (EKG abnormalities, subclinical cardiovascular disease, or a diagnosis of hypertension, diabetes, and hyperlipidemia). Results: Among the 4619 participants with no prior stroke, 650 had an ischemic stroke over a mean 11.5 years of follow up. In models adjust for sociodemographic characteristics, stroke hazard among whites was significantly higher among residents of neighborhoods in the lowest SES quartile relative to those in the highest quartile (Hazard Ratio=1.32; 95% CI 1.01-1.72), but not after adjustment for behavioral risk factors (HR=1.30; 0.99-1.70) or biologic risk factors (HR=1.16; 0.88-1.52). Among African Americans, there was no association between neighborhood disadvantage and stroke. Conclusions: We found shorter time to first ischemic stroke in the most disadvantaged neighborhoods among whites, but not among African Americans. Neighborhood disadvantage appears to influence stroke hazard through higher levels of biologic risk in low income neighborhoods. Incident Ischemic Stroke Hazard Ratios (P), Cardiovascular Health Study Unadjusted HR (P) Model 1 (Adj. for age, sex, income, education) Model 2 (Model 1 + Behavioral Risk Factors) Model 3 (Model 2 + Biologic Risk Factors) Whites (N=3834) Quartile 1 1.00 1.00 1.00 1.00 Quartile 2 1.34 (0.02) 1.27 (0.07) 1.27 (0.07) 1.21 (0.14) Quartile 3 1.43 (0.005) 1.27 (0.07) 1.26 (0.08) 1.16 (0.26) Quartile 4 (Most disadvantaged neighborhood) 1.56 (<0.001) 1.32 (0.04) 1.30 (0.06) 1.15 (0.32)