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Age Ageing. 2013 May;42(3):391-7. doi: 10.1093/ageing/afs179. Epub 2012 Dec 21.

Exploring psychosocial pathways between neighbourhood characteristics and stroke in older adults: the cardiovascular health study.

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1
Department of Resource and Outcomes Management, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Abstract

OBJECTIVES:

to investigate whether psychosocial pathways mediate the association between neighbourhood socioeconomic disadvantage and stroke.

METHODS:

prospective cohort study with a follow-up of 11.5 years.

SETTING:

the Cardiovascular Health Study, a longitudinal population-based cohort study of older adults ≥65 years.

MEASUREMENTS:

the primary outcome was adjudicated incident ischaemic stroke. Neighbourhood socioeconomic status (NSES) was measured using a composite of six census-tract variables. Psychosocial factors were assessed with standard measures for depression, social support and social networks.

RESULTS:

of the 3,834 white participants with no prior stroke, 548 had an incident ischaemic stroke over the 11.5-year follow-up. Among whites, the incident stroke hazard ratio (HR) associated with living in the lowest relative to highest NSES quartile was 1.32 (95% CI = 1.01-1.73), in models adjusted for individual SES. Additional adjustment for psychosocial factors had a minimal effect on hazard of incident stroke (HR = 1.31, CI = 1.00-1.71). Associations between NSES and stroke incidence were not found among African-Americans (n = 785) in either partially or fully adjusted models.

CONCLUSIONS:

psychosocial factors played a minimal role in mediating the effect of NSES on stroke incidence among white older adults.

PMID:
23264005
PMCID:
PMC3633364
DOI:
10.1093/ageing/afs179
[Indexed for MEDLINE]
Free PMC Article
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