Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke

Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke Pages 904-912 M. Maria Glymour, Mauricio Avendaño, Steven Haas, Lisa F. Berkman Close Preview Purchase PDF (206 K) | Related Articles AbstractAbstract | Figures/TablesFigures/Tables | ReferencesReferences Purpose Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities. Methods Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models. Results Black subjects had a 48% greater risk of first stroke incidence than whites (95% confidence interval, 1.33–1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95% CI, 1.00–1.28). Conclusions Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects. Article Outline Introduction Methods Study Population Stroke Outcomes Exposures and Demographic Characteristics Methods of Analysis Results Childhood Social Conditions and Adult Stroke Risk in Black and White HRS Participants Risk Factors From Childhood Through Adulthood and Racial Disparities in Stroke Risk Discussion Comparisons With Previous Studies Study Limitations and Strengths Implications of Findings References