Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke
Lifecourse Social Conditions and Racial Disparities in Incidence of First Stroke
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DOI：
10.1016/j.annepidem.2008.09.010
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发表时间：
2008-12-01
影响因子：
5.6
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.
目的：之前的一些研究发现，在对社会经济地位（SES）进行调整后，黑人受试者的中风率仍然过高，这引发了人们对中风的种族遗传易感性的猜测。之前的研究因社会经济地位评估不完整而受到阻碍，没有对儿童状况或成人财富进行衡量。我们评估了生命全程SES在解释中风风险和中风差异方面的作用。方法：健康与退休研究的50岁以上参与者（n = 20,661）对自我或代理报告的首次中风（2175起事件）进行了平均9.9年的随访。使用 Cox 比例风险模型，将童年社会条件（南方出生状态、父母社会经济地位、自我报告的童年健康状况一般/较差以及达到的身高）、成人社会经济地位（教育、收入、财富和职业地位）和传统心血管危险因素用于预测首次中风发病，并使用 Cox 比例风险模型。 结果：黑人受试者的首次中风发病风险比白人高 48%（95% 置信区间，1.33-1.65）。童年时期的状况可以预测黑人和白人的中风风险，与成人社会经济地位无关。对儿童社会条件和成人 SES 测量进行调整，将种族差异减弱至边际显着性（风险比，1.13；95% CI，1.00-1.28）。结论：儿童社会条件可预测美国黑人和白人成年人的中风风险。对成人社会经济地位（特别是财富）的额外调整几乎消除了黑人和白人受试者之间中风风险的差异。
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.