title: Neighborhood disadvantage and ischemic stroke: the Cardiovascular Health Study (CHS).
abstract: OBJECTIVE
  Neighborhood characteristics may influence the risk of stroke and contribute to socioeconomic disparities in stroke incidence. The objectives of this study were to examine the relationship between neighborhood socioeconomic status and incident ischemic stroke and examine potential mediators of these associations.
  
  
  METHODS
  We analyzed data from 3834 whites and 785 blacks enrolled in the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ages≥65 years from 4 US counties. The primary outcome was adjudicated incident ischemic stroke. Neighborhood socioeconomic status was measured using a composite of 6 census tract variables. Race-stratified multilevel Cox proportional hazard models were constructed adjusted for sociodemographic, behavioral, and biological risk factors.
  
  
  RESULTS
  Among whites, in models adjusted for sociodemographic characteristics, stroke hazard was significantly higher among residents of neighborhoods in the lowest compared with the highest neighborhood socioeconomic status quartile (hazard ratio, 1.32; 95% CI, 1.01-1.72) with greater attenuation of the hazard ratio after adjustment for biological risk factors (hazard ratio, 1.16; 0.88-1.52) than for behavioral risk factors (hazard ratio, 1.30; 0.99-1.70). Among blacks, we found no significant associations between neighborhood socioeconomic status and ischemic stroke.
  
  
  CONCLUSIONS
  Higher risk of incident ischemic stroke was observed in the most disadvantaged neighborhoods among whites, but not among blacks. The relationship between neighborhood socioeconomic status and stroke among whites appears to be mediated more strongly by biological than behavioral risk factors.
authors.affiliation: Department of Neurology, UCLA GIM & HSR, 911 Broxton Plaza, Los Angeles, CA 90024, USA. abrown@mednet.ucla.edu
authors.forename: Arleen F
authors.initials: AF
authors.lastname: Brown
authors.forename: Li-Jung
authors.initials: LJ
authors.lastname: Liang
authors.forename: Stefanie D
authors.initials: SD
authors.lastname: Vassar
authors.forename: Sharon
authors.initials: S
authors.lastname: Stein-Merkin
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Tingjian
authors.initials: T
authors.lastname: Yan
authors.forename: José J
authors.initials: JJ
authors.lastname: Escarce
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011203:Poverty; D012111:Residence Characteristics; D012306:Risk; D012307:Risk Factors; D012923:Social Class; D012931:Social Environment; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D014505:Urban Population