Traditional risk factors as the underlying cause of racial disparities in stroke: lessons from the half-full (empty?) glass.
Traditional risk factors as the underlying cause of racial disparities in stroke: lessons from the half-full (empty?) glass.
复制标题
DOI：
10.1161/strokeaha.111.625277
复制
发表时间：
2011-12
期刊：
影响因子：
8.3
通讯作者：
REasons for Geographic And Racial Differences in Stroke (REGARDS) Investigators
中科院分区：
文献类型：
--
作者：
Howard G;Cushman M;Kissela BM;Kleindorfer DO;McClure LA;Safford MM;Rhodes JD;Soliman EZ;Moy CS;Judd SE;Howard VJ;REasons for Geographic And Racial Differences in Stroke (REGARDS) Investigators
黑人/白色人在卒中发病率上的差异已被充分记录，但很少有研究评估这种差异的原因。在这里，我们评估了“传统”风险因素的贡献。25，714名黑人和白色男性和女性，年龄在45岁以上，基线时无中风，平均随访4.4年以检测中风。中介分析采用比例风险分析评估的贡献，“传统”的风险因素，种族差异。45岁时，黑人发生卒中的风险是白人的2.90倍（95%CI：1.72 - 4.89），65岁时是白人的1.66倍（95%CI：1.34 - 2.07）。调整风险因素后，这些过度分别减少了40%和45%，导致相对风险为2.14（95%CI：1.25 - 3.67）和1.35（95%CI：1.08 - 1.71）。大约一半的这种调解是由于收缩压。进一步调整社会经济因素导致总中介分别为47%和53%，相对风险分别为2.01（95%CI：1.16 - 3.47）和1.30（1.03 - 1.65）。在45至65岁之间，中风风险的种族差异约有一半可归因于传统风险因素（主要是收缩压）和社会经济因素，这表明迫切需要了解这些传统风险因素发展的差异。由于黑人中一半的过度卒中风险不能归因于传统的危险因素和社会经济因素，因此不同种族对危险因素的易感性、剩余混杂因素或非传统危险因素也可能起作用。
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. 25,714 black and white men and women, aged 45+ and stroke-free at baseline were followed for an average of 4.4 years to detect stroke. Mediation analysis employing proportional hazards analysis assessed the contribution of “traditional” risk factors to racial disparities. At age 45, incident stroke risk was 2.90 (95% CI: 1.72 – 4.89) times more likely in blacks than whites, and 1.66 (95% CI: 1.34 – 2.07) times at age 65. 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. 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 racial susceptibility to risk factors, residual confounding or non-traditional risk factors may also play a role.