Neighborhood cohesion is associated with reduced risk of stroke mortality

Cari J Clark, Hongfei Guo, Scott A Lunos, Neelum T. Aggarwal, Todd Beck, Denis A. Evans, Carlos Mendes De Leon, Susan Everson-Rose

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence. METHODS-Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence. RESULTS-Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5). CONCLUSIONS-Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.

Original languageEnglish (US)
Pages (from-to)1212-1217
Number of pages6
JournalStroke
Volume42
Issue number5
DOIs
StatePublished - May 1 2011

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Stroke
Mortality
Incidence
Censuses
Interpersonal Relations
Medicare
Proportional Hazards Models
Social Class
Coronary Disease
Longitudinal Studies
Chronic Disease
Health
Research

Keywords

  • mortality
  • psychosocial
  • social conditions
  • stroke

Cite this

Neighborhood cohesion is associated with reduced risk of stroke mortality. / Clark, Cari J; Guo, Hongfei; Lunos, Scott A; Aggarwal, Neelum T.; Beck, Todd; Evans, Denis A.; Mendes De Leon, Carlos; Everson-Rose, Susan.

In: Stroke, Vol. 42, No. 5, 01.05.2011, p. 1212-1217.

Research output: Contribution to journalArticle

Clark, Cari J ; Guo, Hongfei ; Lunos, Scott A ; Aggarwal, Neelum T. ; Beck, Todd ; Evans, Denis A. ; Mendes De Leon, Carlos ; Everson-Rose, Susan. / Neighborhood cohesion is associated with reduced risk of stroke mortality. In: Stroke. 2011 ; Vol. 42, No. 5. pp. 1212-1217.
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abstract = "BACKGROUND AND PURPOSE-Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence. METHODS-Data come from 5789 participants (60{\%} female; 62{\%} black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence. RESULTS-Each 1-point increase in cohesion related to a 53{\%} reduced risk of stroke mortality (hazard ratio, 0.47; 95{\%} CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95{\%} CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95{\%} CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5). CONCLUSIONS-Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.",
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T1 - Neighborhood cohesion is associated with reduced risk of stroke mortality

AU - Clark, Cari J

AU - Guo, Hongfei

AU - Lunos, Scott A

AU - Aggarwal, Neelum T.

AU - Beck, Todd

AU - Evans, Denis A.

AU - Mendes De Leon, Carlos

AU - Everson-Rose, Susan

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N2 - BACKGROUND AND PURPOSE-Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence. METHODS-Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence. RESULTS-Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5). CONCLUSIONS-Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.

AB - BACKGROUND AND PURPOSE-Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence. METHODS-Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence. RESULTS-Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5). CONCLUSIONS-Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.

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