title: Exploring psychosocial pathways between neighbourhood characteristics and stroke in older adults: the cardiovascular health study.
abstract: OBJECTIVE
  to investigate whether psychosocial pathways mediate the association between neighbourhood socioeconomic disadvantage and stroke.
  
  
  METHODS
  prospective cohort study with a follow-up of 11.5 years.
  
  
  METHODS
  the Cardiovascular Health Study, a longitudinal population-based cohort study of older adults ≥65 years.
  
  
  METHODS
  the primary outcome was adjudicated incident ischaemic stroke. Neighbourhood socioeconomic status (NSES) was measured using a composite of six census-tract variables. Psychosocial factors were assessed with standard measures for depression, social support and social networks.
  
  
  RESULTS
  of the 3,834 white participants with no prior stroke, 548 had an incident ischaemic stroke over the 11.5-year follow-up. Among whites, the incident stroke hazard ratio (HR) associated with living in the lowest relative to highest NSES quartile was 1.32 (95% CI = 1.01-1.73), in models adjusted for individual SES. Additional adjustment for psychosocial factors had a minimal effect on hazard of incident stroke (HR = 1.31, CI = 1.00-1.71). Associations between NSES and stroke incidence were not found among African-Americans (n = 785) in either partially or fully adjusted models.
  
  
  CONCLUSIONS
  psychosocial factors played a minimal role in mediating the effect of NSES on stroke incidence among white older adults.
authors.affiliation: Department of Resource and Outcomes Management, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Tingjian
authors.initials: T
authors.lastname: Yan
authors.forename: José J
authors.initials: JJ
authors.lastname: Escarce
authors.forename: Li-Jung
authors.initials: LJ
authors.lastname: Liang
authors.forename: W T
authors.initials: WT
authors.lastname: Longstreth
authors.forename: Sharon Stein
authors.initials: SS
authors.lastname: Merkin
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Stefanie D
authors.initials: SD
authors.lastname: Vassar
authors.forename: Teresa
authors.initials: T
authors.lastname: Seeman
authors.forename: Catherine
authors.initials: C
authors.lastname: Sarkisian
authors.forename: Arleen F
authors.initials: AF
authors.lastname: Brown
mesh_terms: D001741:Black or African American / Q000523:psychology; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D002545:Brain Ischemia / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012111:Residence Characteristics; D018570:Risk Assessment; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology*; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D035862:Vulnerable Populations; D044465:White People / Q000523:psychology