Lifecourse social conditions and racial disparities in incidence of first stroke.

TitleLifecourse social conditions and racial disparities in incidence of first stroke.
Publication TypeJournal Article
Year of Publication2008
AuthorsM. Glymour, M, Avendano, M, Haas, SA, Berkman, LF
JournalAnn Epidemiol
Date Published2008 Dec
ISSN Number1873-2585
Call Numbernewpubs20090126_Glymour_AE
KeywordsAged, Aged, 80 and over, Black or African American, Cardiovascular Diseases, ethnicity, Female, Health Status Disparities, Humans, Incidence, Interviews as Topic, Life Style, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Risk Factors, Social Environment, Socioeconomic factors, Stroke, United States, White People

PURPOSE: Some previous studies found excess stroke rates among black subjects persisted after adjustment for socioeconomic status (SES), fueling speculation regarding racially patterned genetic predispositions to stroke. Previous research was hampered by incomplete SES assessments, without measures of childhood conditions or adult wealth. We assess the role of lifecourse SES in explaining stroke risk and stroke disparities.

METHODS: Health and Retirement Study participants age 50+ (n = 20,661) were followed on average 9.9 years for self- or proxy-reported first stroke (2175 events). Childhood social conditions (southern state of birth, parental SES, self-reported fair/poor childhood health, and attained height), adult SES (education, income, wealth, and occupational status) and traditional cardiovascular risk factors were used to predict first stroke onset using Cox proportional hazards models.

RESULTS: Black subjects had a 48% greater risk of first stroke incidence than whites (95% confidence interval, 1.33-1.65). Childhood conditions predicted stroke risk in both blacks and whites, independently of adult SES. Adjustment for both childhood social conditions and adult SES measures attenuated racial differences to marginal significance (hazard ratio, 1.13; 95% CI, 1.00-1.28).

CONCLUSIONS: Childhood social conditions predict stroke risk in black and White American adults. Additional adjustment for adult SES, in particular wealth, nearly eliminated the disparity in stroke risk between black and white subjects.

User Guide Notes

Endnote Keywords

Stroke/Socioeconomic Factors/Life Cycle/African-Americans

Endnote ID


Alternate JournalAnn Epidemiol
Citation Key7260
PubMed ID19041589
PubMed Central IDPMC2796851
Grant ListR01 AG023399 / AG / NIA NIH HHS / United States
R01 AG023399-03 / AG / NIA NIH HHS / United States
AG023399 / AG / NIA NIH HHS / United States