title: Neighborhood cohesion is associated with reduced risk of stroke mortality.
abstract: OBJECTIVE
  Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence.
  
  
  METHODS
  Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence.
  
  
  RESULTS
  Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5).
  
  
  CONCLUSIONS
  Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.
authors.affiliation: University of Minnesota, 717 Delaware Street, SE, Suite 166, Minneapolis, MN 55414, USA.
authors.forename: Cari Jo
authors.initials: CJ
authors.lastname: Clark
authors.forename: Hongfei
authors.initials: H
authors.lastname: Guo
authors.forename: Scott
authors.initials: S
authors.lastname: Lunos
authors.forename: Neelum T
authors.initials: NT
authors.lastname: Aggarwal
authors.forename: Todd
authors.initials: T
authors.lastname: Beck
authors.forename: Denis A
authors.initials: DA
authors.lastname: Evans
authors.forename: Carlos
authors.initials: C
authors.lastname: Mendes de Leon
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007398:Interpersonal Relations; D008137:Longitudinal Studies; D008297:Male; D017063:Outcome Assessment, Health Care; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality*; D015996:Survival Rate; D044465:White People / Q000208:ethnology