title: Does socioeconomic status or acculturation modify the association between ethnicity and hypertension treatment before stroke?
abstract: OBJECTIVE
  Socioeconomic status and acculturation may modify the association between ethnicity and hypertension treatment before stroke. We assessed prestroke treatment of hypertension by ethnicity, education (proxy for socioeconomic status), and English proficiency (EP; proxy for acculturation) in a population-based stroke surveillance project.
  
  
  METHODS
  Among 763 patients with first-ever stroke aged ≥45 years in the Brain Attack Surveillance in Corpus Christi project from 2000 to 2006, we examined self-reported hypertension treatment at the time of the stroke by ethnicity (Mexican American [MA] versus non-Hispanic white [NHW]) in the overall sample, within education strata (<high school, high school, >high school), and after dichotomizing MAs by self-reported EP (limited versus proficient). Logistic regression adjusted associations for age, sex, education, diabetes mellitus, coronary artery disease, hypercholesterolemia, and health insurance.
  
  
  RESULTS
  NHWs and MAs reported similar hypertension treatment (84% versus 86%; P=0.53). Hypertension treatment was 84% for NHWs and 90% for MAs (P=0.18) in <high school stratum, 87% for NHWs and 75% for MAs (P=0.07) in high school stratum, and 81% for NHWs and 78% for MAs (P=0.73) in >high school stratum (ethnicity-by-education interaction, P=0.09). Hypertension treatment was 83% for NHWs, 87% for MAs with EP (PvsNHWs=0.35), and 90% for MAs with limited EP (PvsNHWs=0.13; ethnicity-by-EP interaction, P=0.22). Hypertension treatment was lower in uninsured patients (adjusted odds ratio, 0.13; 95% confidence interval, 0.03-0.60) or those with no physician visit ≤6 months (adjusted odds ratio, 0.09; 95% confidence interval, 0.03-0.24).
  
  
  CONCLUSIONS
  We found no evidence that socioeconomic status or acculturation modifies the association between ethnicity and hypertension treatment before stroke.
authors.affiliation: From the Division of General Medicine and HSR&D Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (D.A.L., K.M.L.); and Stroke Program (D.A.L., L.B.M., L.E.S., M.A.S., L.D.L.), Department of Epidemiology (L.B.M., L.D.L.), Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor, MI.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Levine
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Langa
authors.forename: Lesli E
authors.initials: LE
authors.lastname: Skolarus
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Smith
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
mesh_terms: D000069:Acculturation; D000368:Aged; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D012923:Social Class; D020521:Stroke / Q000175:diagnosis* / Q000208:ethnology* / Q000517:prevention & control; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome
keywords: acculturation; ethnicity; hypertension; socioeconomic status; treatment
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