Traditional Risk Factors as the Underlying Cause of Racial Disparities in Stroke

  • George Howard
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Mary Cushman
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Brett M. Kissela
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Dawn O. Kleindorfer
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Leslie A. McClure
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Monika M. Safford
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • J. David Rhodes
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Elsayed Z. Soliman
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Claudia S. Moy
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Suzanne E. Judd
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...
  • Virginia J. Howard
    From the Department of Biostatistics (G.H., L.A.M., J.D.R., S.E.J.) and Department of Epidemiology (V.J.H.), School of Public Health, and Deep South Center on Effectiveness at the Birmingham Veterans Affairs Medical Center and the Division of Preventive Medicine, Department of Medicine (M.M.S.), University of Alabama at Birmingham, Birmingham, AL; Department of Medicine (M.C.), University of Vermont College of Medicine, Burlington, VT; Department of Neurology (B.M.K., D.O.K.), University of...

書誌事項

タイトル別名
  • Lessons From the Half-Full (Empty?) Glass

抄録

<jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>Black/white disparities in stroke incidence are well documented, but few studies have assessed the contributions to the disparity. Here we assess the contribution of “traditional” risk factors.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>A total of 25 714 black and white men and women, aged ≥45 years and stroke-free at baseline, were followed for an average of 4.4 years to detect stroke. Mediation analysis using proportional hazards analysis assessed the contribution of traditional risk factors to racial disparities.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p>At age 45 years, incident stroke risk was 2.90 (95% CI: 1.72–4.89) times more likely in blacks than in whites and 1.66 (95% CI: 1.34–2.07) times at age 65 years. Adjustment for risk factors attenuated these excesses by 40% and 45%, respectively, resulting in relative risks of 2.14 (95% CI: 1.25–3.67) and 1.35 (95% CI: 1.08–1.71). Approximately one half of this mediation is attributable to systolic blood pressure. Further adjustment for socioeconomic factors resulted in total mediation of 47% and 53% to relative risks of 2.01 (95% CI: 1.16–3.47) and 1.30 (1.03–1.65), respectively.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Between ages 45 to 65 years, approximately half of the racial disparity in stroke risk is attributable to traditional risk factors (primarily systolic blood pressure) and socioeconomic factors, suggesting a critical need to understand the disparity in the development of these traditional risk factors. Because half of the excess stroke risk in blacks is not attributable to traditional risk factors and socioeconomic factors, differential impact of risk factors, residual confounding, or nontraditional risk factors may also play a role.</jats:p> </jats:sec>

収録刊行物

  • Stroke

    Stroke 42 (12), 3369-3375, 2011-12

    Ovid Technologies (Wolters Kluwer Health)

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