title: Stroke incidence in older US Hispanics: is foreign birth protective?
abstract: OBJECTIVE
  Although Hispanics are the fastest growing ethnic group in the United States, relatively little is known about stroke risk in US Hispanics. We compare stroke incidence and socioeconomic predictors in US- and foreign-born Hispanics with patterns among non-Hispanic whites.
  
  
  METHODS
  Health and Retirement Study participants aged 50+ years free of stroke in 1998 (mean baseline age, 66.3 years) were followed through 2008 for self- or proxy-reported first stroke (n=15 784; 1388 events). We used discrete-time survival analysis to compare stroke incidence among US-born (including those who immigrated before age 7 years) and foreign-born Hispanics with incidence in non-Hispanic whites. We also examined childhood and adult socioeconomic characteristics as predictors of stroke among Hispanics, comparing effect estimates with those for non-Hispanic whites.
  
  
  RESULTS
  In age- and sex-adjusted models, US-born Hispanics had higher odds of stroke onset than non-Hispanic whites (OR, 1.44; 95% CI, 1.08-1.90), but these differences were attenuated and nonsignificant in models that controlled for childhood and adulthood socioeconomic factors (OR, 1.07; 95% CI, 0.80-1.42). In contrast, in models adjusted for all demographic and socioeconomic factors, foreign-born Hispanics had significantly lower stroke risk than non-Hispanic whites (OR, 0.58; 95% CI, 0.41-0.81). The impact of socioeconomic predictors on stroke did not differ between Hispanics and whites.
  
  
  CONCLUSIONS
  In this longitudinal national cohort, foreign-born Hispanics had lower incidence of stroke incidence than non-Hispanic whites and US-born Hispanics. Findings suggest that foreign-born Hispanics may have a risk factor profile that protects them from stroke as compared with other Americans.
authors.affiliation: Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: J Robin
authors.initials: JR
authors.lastname: Moon
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Capistrant
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.forename: Mauricio
authors.initials: M
authors.lastname: Avendaño
authors.forename: S V
authors.initials: SV
authors.lastname: Subramanian
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bates
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004641:Emigration and Immigration; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology*