4.7 Article

Neighborhood socioeconomic disadvantage and mortality after stroke

期刊

NEUROLOGY
卷 80, 期 6, 页码 520-527

出版社

LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e31828154ae

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资金

  1. American Heart Association PRT-Spina Outcomes Research Center [0875135N]
  2. Los Angeles Stroke Prevention/Intervention Research Program in Health Disparities [U54NS081764]
  3. National Heart, Lung, and Blood Institute [N01-HC-85239, N01-HC-85079, N01-HC-85080, N01-HC-85081, N01-HC-85082, N01-HC-85083, N01-HC-85084, N01-HC-85085, N01-HC-85086, N01-HC-35129, N01 HC-15103, N01 HC-55222, N01-HC-75150, N01-HC-45133, HL080295]
  4. National Institute on Aging [AG-023629, AG-15928, AG-20098, AG-027058]
  5. NIH/National Center for Advancing Clinical and Translational Science [UL1TR000124]
  6. NIH
  7. American Heart Association PRT-Spina Outcomes Research Center

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Objective: Residence in a socioeconomically disadvantaged community is associated with mortality, but the mechanisms are not well understood. We examined whether socioeconomic features of the residential neighborhood contribute to poststroke mortality and whether neighborhood influences are mediated by traditional behavioral and biologic risk factors. Methods: We used data from the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults >= 65 years. Residential neighborhood disadvantage was measured using neighborhood socioeconomic status (NSES), a composite of 6 census tract variables representing income, education, employment, and wealth. Multilevel Cox proportional hazard models were constructed to determine the association of NSES to mortality after an incident stroke, adjusted for sociodemographic characteristics, stroke type, and behavioral and biologic risk factors. Results: Among the 3,834 participants with no prior stroke at baseline, 806 had a stroke over a mean 11.5 years of follow-up, with 168 (20%) deaths 30 days after stroke and 276 (34%) deaths at 1 year. In models adjusted for demographic characteristics, stroke type, and behavioral and biologic risk factors, mortality hazard 1 year after stroke was significantly higher among residents of neighborhoods with the lowest NSES than those in the highest NSES neighborhoods (hazard ratio 1.77, 95% confidence interval 1.17-2.68). Conclusion: Living in a socioeconomically disadvantaged neighborhood is associated with higher mortality hazard at 1 year following an incident stroke. Further work is needed to understand the structural and social characteristics of neighborhoods that may contribute to mortality in the year after a stroke and the pathways through which these characteristics operate. Neurology (R) 2013;80:520-527

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