Race, Marital History, and Risks for Stroke in US Older Adults
Race, Marital History, and Risks for Stroke in US Older Adults
复制标题
DOI：
10.1093/sf/sow040
复制
发表时间：
2016-09-01
期刊：
影响因子：
4.8
通讯作者：
Dupre, Matthew E.
中科院分区：
文献类型：
--
作者：
Dupre, Matthew E.
中风是美国残疾和死亡的主要原因之一，中风的种族差异大于所有其他主要慢性病。考虑到婚姻生活中同样相当大的种族差异和成年后的相关风险，目前的研究假设婚姻史中的黑人-白人差异在中风发病率的种族不平等中起着重要作用。主要目的是（i）证明婚姻史如何与卒中发病率相关，（ii）检查婚姻因素如何介导和/或调节卒中的种族差异，以及（iii）检查可能解释相关性的因素。使用健康和退休研究（n = 23，289）的回顾性和前瞻性数据，结果显示，与NH白人相比，非西班牙裔（NH）黑人的婚姻不稳定率显着更高，健康风险因素数量更多，中风率也更高。与累积劣势假设相反，离散时间风险模型的研究结果表明，婚姻史的影响对NH白人比NH黑人更明显。与连续结婚的NH白人相比，目前离婚、再婚和丧偶的NH白人以及有离婚或丧偶史的NH白人中风风险显著较高。在新罕布什尔州的黑人中，中风的风险仅在那些从未结婚或丧偶的人中升高，离婚没有显著的风险。潜在的关联机制进行了评估，并讨论了研究结果的影响。
Stroke is among the leading causes of disability and death in the United States, and racial differences are greater for stroke than for all other major chronic diseases. Considering the equally sizeable racial disparities in marital life and associated risks across adulthood, the current study hypothesizes that black-white differences in marital history play an important role in the large racial inequalities in the incidence of stroke. The major objective are to (i) demonstrate how marital history is associated with the incidence of stroke, (ii) examine how marital factors mediate and/or moderate racial disparities in stroke, and (iii) examine the factors that may explain the associations. Using retrospective and prospective data from the Health and Retirement Study (n = 23,289), the results show that non-Hispanic (NH) blacks have significantly higher rates of marital instability, greater numbers of health-risk factors, and substantially higher rates of stroke compared with NH whites. Contrary to the cumulative disadvantage hypothesis, findings from discrete-time-hazard models show that the effects of marital history are more pronounced for NH whites than for NH blacks. Risks for stroke were significantly higher in NH whites who were currently divorced, remarried, and widowed, as well as in those with a history of divorce or widowhood, compared with NH whites who were continuously married. In NH blacks, risks for stroke were elevated only in those who had either never married or had been widowed-with no significant risks attributable to divorce. The potential mechanisms underlying the associations are assessed, and the implications of the findings are discussed.