Neighborhood Cohesion Is Associated With Reduced Risk of Stroke Mortality
Neighborhood Cohesion Is Associated With Reduced Risk of Stroke Mortality
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DOI：
10.1161/strokeaha.110.609164
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发表时间：
2011-05-01
期刊：
影响因子：
8.3
通讯作者：
Everson-Rose, Susan A.
中科院分区：
文献类型：
--
作者：
Clark, Cari Jo;Guo, Hongfei;Everson-Rose, Susan A.
背景和目的--更大的社会凝聚力与较低的冠心病发病率相关，但其与中风风险的关系尚未得到研究。这项研究检验了社区社会凝聚力是否对中风的死亡率和发病率具有保护作用。方法-数据来自5789名参与者(女性60%，黑人62%，平均年龄74.7岁)，参与了一项关于老年人慢性病的纵向研究。截至2007年12月31日确认的中风死亡率通过国家死亡指数进行了核实；在11年的随访中确认了186例中风死亡。在与联邦医疗保险索赔文件相关联的子集(N=3816)中确定了中风发生率；识别了701例首次中风。凝聚力通过评估与邻居的联系频率和社会互动的6个项目来衡量；项目被Z评分并取平均值。82个人口普查区组的个人得分平均，形成了社区层面的社会凝聚力衡量标准。结果：社区凝聚力每增加1分，中风死亡率降低53%(风险比0.47；95%可信区间0.24至0.90)，调整相关协变量，包括社会人口学、已知的中风风险因素和社区层面的社会经济状况。种族与凝聚力的交互作用(P=0.04)显示，凝聚力在白人中是保护性的(风险比0.34；95%CI，0.17至0.67)，但对黑人(风险比1.17；95%CI，0.35至3.86)没有保护作用。凝聚力与卒中发病率无关(P>；0.5)。结论：社区层面的社会凝聚力对卒中死亡率具有独立的保护作用。需要进一步研究观察到的种族差异和凝聚力具有健康保护作用的途径。(笔划。2011；42：1212-1217。)
Background and Purpose-Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence.Methods-Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N = 3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence.Results-Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race x cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5).Conclusions-Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective. (Stroke. 2011;42:1212-1217.)