title: Neighborhood socioeconomic disadvantage and mortality after stroke.
abstract: OBJECTIVE
  Residence in a socioeconomically disadvantaged community is associated with mortality, but the mechanisms are not well understood. We examined whether socioeconomic features of the residential neighborhood contribute to poststroke mortality and whether neighborhood influences are mediated by traditional behavioral and biologic risk factors.
  
  
  METHODS
  We used data from the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ≥65 years. Residential neighborhood disadvantage was measured using neighborhood socioeconomic status (NSES), a composite of 6 census tract variables representing income, education, employment, and wealth. Multilevel Cox proportional hazard models were constructed to determine the association of NSES to mortality after an incident stroke, adjusted for sociodemographic characteristics, stroke type, and behavioral and biologic risk factors.
  
  
  RESULTS
  Among the 3,834 participants with no prior stroke at baseline, 806 had a stroke over a mean 11.5 years of follow-up, with 168 (20%) deaths 30 days after stroke and 276 (34%) deaths at 1 year. In models adjusted for demographic characteristics, stroke type, and behavioral and biologic risk factors, mortality hazard 1 year after stroke was significantly higher among residents of neighborhoods with the lowest NSES than those in the highest NSES neighborhoods (hazard ratio 1.77, 95% confidence interval 1.17-2.68).
  
  
  CONCLUSIONS
  Living in a socioeconomically disadvantaged neighborhood is associated with higher mortality hazard at 1 year following an incident stroke. Further work is needed to understand the structural and social characteristics of neighborhoods that may contribute to mortality in the year after a stroke and the pathways through which these characteristics operate.
authors.affiliation: Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, 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 Stein
authors.initials: SS
authors.lastname: 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; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000191:economics / Q000401:mortality*; D035862:Vulnerable Populations