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Multicenter Study
. 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

Tingjian Yan  1 , José J Escarce, Li-Jung Liang, W T Longstreth Jr, Sharon Stein Merkin, Bruce Ovbiagele, Stefanie D Vassar, Teresa Seeman, Catherine Sarkisian, Arleen F Brown
Affiliations
Multicenter Study

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

Tingjian Yan et al. Age Ageing. 2013 May.

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.

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Figures

Figure 1.
Figure 1.
The mediating effects of psychosocial factors between NSES and incident ischaemic stroke. Age, gender, marital status, individual education and income were adjusted in these pathways.
See this image and copyright information in PMC

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