Is the 'Stroke Belt' worn from childhood?: Risk of first stroke and state of residence in childhood and adulthood
Is the 'Stroke Belt' worn from childhood?: Risk of first stroke and state of residence in childhood and adulthood
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DOI：
10.1161/strokeaha.107.482059
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发表时间：
2007-09-01
期刊：
影响因子：
8.3
通讯作者：
Berkman, Lisa F.
中科院分区：
文献类型：
--
作者：
Glymour, M. Maria;Avendano, Mauricio;Berkman, Lisa F.
背景和目的--大多数卒中带研究根据卒中发作时的居住地定义暴露。我们评估了童年时期居住在中风带是否会增加成年后中风的风险，即使是那些离开该地区的人。方法-无中风健康和退休研究参与者（n = 18 070）随访（平均，8.4年）1452例事件被分类为儿童期或研究入组时生活在7个卒中带状态之一（平均年龄63岁）。我们使用考克斯比例风险模型来比较从未在中风带居住过的人与在两个年龄段都在那里居住过的人（仅在童年或仅在成年时）的中风风险。结果-与从未在中风带居住过的人相比，中风带居住在童年和成年时的风险比为1.23（95% CI，1.06，1.43），仅在儿童期居住的卒中带为1.25（95% CI，1.02，1.55）。在入组时而非儿童期居住在卒中带与卒中风险无显著相关性（风险比= 1.01; 95%CI，0.70，1.46），但该组的小样本导致了较宽的CI。在调整危险因素（包括综合成人社会经济指标）后，结果变化不大。亚组分析发现，按性别和出生队列划分的模式相似。相比之下，黑人谁住在中风带在童年只有没有出现有显着升高的中风风险相比，黑人谁从来没有住在中风Belt.Conclusions -中风的人谁住在中风带国家在童年的过度中风风险牵连早期生活暴露在中风带的病因。
Background and Purpose - Most Stroke Belt studies define exposure based on residence at stroke onset. We assessed whether residence in the Stroke Belt during childhood confers extra stroke risk in adulthood, even among people who left the region.Methods - Stroke-free Health and Retirement Study participants (n = 18 070) followed up (average, 8.4 years) for first stroke (1452 events) were classified as living in 1 of 7 Stroke Belt states in childhood or at study enrollment (average age, 63 years). We used Cox proportional-hazards models to compare stroke risk for people who had never lived in the Stroke Belt with those who had lived there at both ages, in childhood only, or in adulthood only.Results - Compared with never having lived in the Stroke Belt, the hazard ratio for Stroke Belt residence in both childhood and adulthood was 1.23 (95% CI, 1.06, 1.43) and for Stroke Belt residence in childhood only was 1.25 (95% CI, 1.02, 1.55). Stroke Belt residence at enrollment but not during childhood was not significantly related to stroke risk (hazard ratio = 1.01; 95% CI, 0.70, 1.46), but the small sample in this group resulted in wide CIs. Results changed little after risk factor adjustment, including comprehensive adult socioeconomic measures. Subgroup analyses found similar patterns by sex and birth cohort. In contrast, blacks who had lived in the Stroke Belt in childhood only did not appear to have significantly elevated stroke risk compared with blacks who had never lived in the Stroke Belt.Conclusions - The excess stroke risk for people who had lived in Stroke Belt states during childhood implicates early life exposures in the etiology of the Stroke Belt.