Lifecourse social conditions and racial disparities in incidence of first stroke.
OBJECTIVE
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.
Glymour
M Maria
MM
Department of Epidemiology, Mailman School of Public Health, New York, NY, USA. mglymour@hsph.harvard.edu
Avendaño
Mauricio
M
Haas
Steven
S
Berkman
Lisa F
LF
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012307:Risk Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*