Abstract 2562: Neighborhood Poverty, Personal Income and Incident Stroke in Black and White Participants in the REGARDS Study
Background. Neighborhood poverty has been identified as an important risk factor for coronary heart disease, with an association that is independent of individual income. Associations of poverty with stroke outcomes have been mixed, and not all studies have included adjustment for risk factors.
Methods. The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study is a national, population-based, longitudinal study of 30,239 black and white adults > 45 years, enrolled 2003-2007. Baseline data collection included a centralized telephone interview for demographics and medical history and an in-home evaluation for physical measures. Participants are subsequently telephoned bi-annually for self- or proxy-reported stroke; then medical records are retrieved and adjudicated by physicians. Baseline home addresses were geocoded and linked to census tract, and percentage of census tract living below federal poverty level was determined from the 2000 US Census. Neighborhoods were stratified as wealthier (poverty levels below 15%) and poorer (15% and above). Participants reporting a physician-diagnosed stroke at baseline, missing income, < 80% reliability on geocoding, or no follow-up were excluded, leaving n=20,596. These participants resided across 10,471 census tracts. Proportional hazard models were fit to establish the association of incident stroke with neighborhood poverty within strata of personal income by race, adjusting for age, sex, and region (Stroke Belt, Buckle, or other) and further adjustment for education and Framingham stroke risk factors.
Results. There were 460 strokes in the analysis cohort of 8,637 blacks and 11,959 whites; mean age was 64.5 years; 54% were women. After controlling for age, sex, region, and personal income, neighborhood poverty was not associated with increased stroke risk. However, there was a trend for blacks with low incomes and whites with high incomes to have increased risk if they lived in a poor neighborhood (see figure). Further adjustment for education and stroke risk factors did not substantially alter results.
Conclusions. We observed that within most levels of personal income, neighborhood poverty was not associated with stroke risk; however, there was an intriguing suggestion that residence in poor neighborhoods increases the risk for low income blacks and high income whites. Additional work using other measures of neighborhood socioeconomic status may be warranted.
- © 2012 by American Heart Association, Inc.