Race-ethnic disparities in the impact of stroke risk factors: the northern Manhattan stroke study.
OBJECTIVE
Stroke risk factors have been determined in large part through epidemiological studies in white cohorts; as a result, race-ethnic disparities in stroke incidence and mortality rates remained unexplained. The aim in the present study was to compare the prevalence, OR, and etiological fraction (EF) of stroke risk factors among white, blacks, and Caribbean Hispanics living in the same urban community of northern Manhattan.


METHODS
In this population-based incident case-control study, cases (n=688) of first ischemic stroke were prospectively matched 1:2 by age, sex, and race-ethnicity with community controls (n=1156). Risk factors were determined through in-person assessment. Conditional logistic regression was used to calculate adjusted ORs in each race-ethnic group. Prevalence and multivariate EFs were determined in each race-ethnic group.


RESULTS
Hypertension was an independent risk factor for whites (OR 1.8, EF 25%), blacks (OR 2.0, EF 37%), and Caribbean Hispanics (OR 2.1, EF 32%), but greater prevalence led to elevated EFs among blacks and Caribbean Hispanics. Greater prevalence rates of diabetes increased stroke risk in blacks (OR 1.8, EF 14%) and Caribbean Hispanics (OR 2.1 P<0.05, EF 10%) compared with whites (OR 1.0, EF 0%), whereas atrial fibrillation had a greater prevalence and EF for whites (OR 4.4, EF 20%) compared with blacks (OR 1.7, EF 3%) and Caribbean Hispanics (OR 3.0, EF 2%). Coronary artery disease was most important for whites (OR 1.3, EF 16%), followed by Caribbean Hispanics (OR 1.5, EF 6%) and then blacks (OR 1.1, EF 2%). Prevalence of physical inactivity was greater in Caribbean Hispanics, but an elevated EF was found in all groups.


CONCLUSIONS
The prevalence, OR, and EF for stroke risk factors vary by race-ethnicity. These differences are crucial to the etiology of stroke, as well as to the design and implementation of stroke prevention programs.
Sacco
R L
RL
Columbia University College of Physicians and Surgeons and School of Public Health, New York, NY, USA.
Boden-Albala
B
B
Abel
G
G
Lin
I F
IF
Elkind
M
M
Hauser
W A
WA
Paik
M C
MC
Shea
S
S
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology; D044383:Black People / Q000235:genetics; D016022:Case-Control Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D020022:Genetic Predisposition to Disease; D006630:Hispanic or Latino / Q000235:genetics; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D016015:Logistic Models; D008297:Male; D009519:New York City / Q000453:epidemiology; D016017:Odds Ratio; D010809:Physical Fitness; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology* / Q000235:genetics; D014900:West Indies / Q000208:ethnology; D044465:White People / Q000235:genetics; D001741:Black or African American