Neighborhood differences in post-stroke mortality

Theresa L. Osypuk, Amy Ehntholt, J. Robin Moon, Paola Gilsanz, M. Maria Glymour

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background - Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher poststroke mortality, and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke. Methods and Results - Health and Retirement Study participants aged ≥50 years without stroke at baseline (n=15 560) were followed ≤12 years for incident stroke (1715 events over 159 286 person-years) and mortality (5325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black, or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus people without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (hazard ratio, 0.75 for neighborhoods in highest 25th percentile versus below, 95% confidence interval, 0.62-0.91) more strongly than for stroke-free adults (hazard ratio, 0.92; 95% confidence interval, 0.83-1.02; P=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within 3 months after stroke, when associations were often stronger than among stroke-free individuals. Conclusions - Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.

Original languageEnglish (US)
Article numbere002547
JournalCirculation: Cardiovascular Quality and Outcomes
Volume10
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Stroke
Mortality
Confidence Intervals
Survival
Retirement
Vulnerable Populations
Censuses
Poverty
Proportional Hazards Models
Population
Survivors
Demography

Keywords

  • community
  • mortality
  • neighborhood
  • social support
  • socioeconomic factors
  • stroke

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

Cite this

Neighborhood differences in post-stroke mortality. / Osypuk, Theresa L.; Ehntholt, Amy; Moon, J. Robin; Gilsanz, Paola; Glymour, M. Maria.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 10, No. 2, e002547, 01.02.2017.

Research output: Contribution to journalArticle

Osypuk, Theresa L. ; Ehntholt, Amy ; Moon, J. Robin ; Gilsanz, Paola ; Glymour, M. Maria. / Neighborhood differences in post-stroke mortality. In: Circulation: Cardiovascular Quality and Outcomes. 2017 ; Vol. 10, No. 2.
@article{42ff8f94b6544576a4cac508b3a71bdd,
title = "Neighborhood differences in post-stroke mortality",
abstract = "Background - Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher poststroke mortality, and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke. Methods and Results - Health and Retirement Study participants aged ≥50 years without stroke at baseline (n=15 560) were followed ≤12 years for incident stroke (1715 events over 159 286 person-years) and mortality (5325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black, or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus people without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (hazard ratio, 0.75 for neighborhoods in highest 25th percentile versus below, 95{\%} confidence interval, 0.62-0.91) more strongly than for stroke-free adults (hazard ratio, 0.92; 95{\%} confidence interval, 0.83-1.02; P=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within 3 months after stroke, when associations were often stronger than among stroke-free individuals. Conclusions - Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.",
keywords = "community, mortality, neighborhood, social support, socioeconomic factors, stroke",
author = "Osypuk, {Theresa L.} and Amy Ehntholt and Moon, {J. Robin} and Paola Gilsanz and Glymour, {M. Maria}",
year = "2017",
month = "2",
day = "1",
doi = "10.1161/CIRCOUTCOMES.116.002547",
language = "English (US)",
volume = "10",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Neighborhood differences in post-stroke mortality

AU - Osypuk, Theresa L.

AU - Ehntholt, Amy

AU - Moon, J. Robin

AU - Gilsanz, Paola

AU - Glymour, M. Maria

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background - Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher poststroke mortality, and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke. Methods and Results - Health and Retirement Study participants aged ≥50 years without stroke at baseline (n=15 560) were followed ≤12 years for incident stroke (1715 events over 159 286 person-years) and mortality (5325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black, or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus people without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (hazard ratio, 0.75 for neighborhoods in highest 25th percentile versus below, 95% confidence interval, 0.62-0.91) more strongly than for stroke-free adults (hazard ratio, 0.92; 95% confidence interval, 0.83-1.02; P=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within 3 months after stroke, when associations were often stronger than among stroke-free individuals. Conclusions - Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.

AB - Background - Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher poststroke mortality, and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke. Methods and Results - Health and Retirement Study participants aged ≥50 years without stroke at baseline (n=15 560) were followed ≤12 years for incident stroke (1715 events over 159 286 person-years) and mortality (5325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black, or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus people without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (hazard ratio, 0.75 for neighborhoods in highest 25th percentile versus below, 95% confidence interval, 0.62-0.91) more strongly than for stroke-free adults (hazard ratio, 0.92; 95% confidence interval, 0.83-1.02; P=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within 3 months after stroke, when associations were often stronger than among stroke-free individuals. Conclusions - Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.

KW - community

KW - mortality

KW - neighborhood

KW - social support

KW - socioeconomic factors

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=85014690398&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014690398&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.116.002547

DO - 10.1161/CIRCOUTCOMES.116.002547

M3 - Article

VL - 10

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 2

M1 - e002547

ER -