Stroke disparities in older Americans: is wealth a more powerful indicator of risk than income and education?

Details

Serval ID
serval:BIB_81FB8B849D1A
Type
Article: article from journal or magazin.
Collection
Publications
Title
Stroke disparities in older Americans: is wealth a more powerful indicator of risk than income and education?
Journal
Stroke
Author(s)
Avendano M., Glymour M.M.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
05/2008
Peer-reviewed
Oui
Volume
39
Number
5
Pages
1533-1540
Language
english
Notes
Publication types: Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
This study examines the independent effect of wealth, income, and education on stroke and how these disparities evolve throughout middle and old age in a representative cohort of older Americans.
Stroke-free participants in the Health and Retirement Study (n=19,565) were followed for an average of 8.5 years. Total wealth, income, and education assessed at baseline were used in Cox proportional hazards models to predict time to stroke. Separate models were estimated for 3 age-strata (50 to 64, 65 to 74, and >or=75), and incorporating risk factor measures (smoking, physical activity, body mass index, hypertension, diabetes, and heart disease).
1542 subjects developed incident stroke. Higher education predicted reduced stroke risk at ages 50 to 64, but not after adjustment for wealth and income. Wealth and income were independent risk factors for stroke at ages 50 to 64. Adjusted hazard ratios comparing the lowest decile with the 75th-90th percentiles were 2.3 (95% CI 1.6, 3.4) for wealth and 1.8 (95% CI 1.3, 2.6) for income. Risk factor adjustment attenuated these effects by 30% to 50%, but coefficients for both wealth (HR=1.7, 95% CI 1.2, 2.5) and income (HR=1.6, 95% CI 1.2, 2.3) remained significant. Wealth, income, and education did not consistently predict stroke beyond age 65.
Wealth and income are independent predictors of stroke at ages 50 to 64 but do not predict stroke among the elderly. This age patterning might reflect buffering of the negative effect of low socioeconomic status by improved access to social and health care programs at old ages, but may also be an artifact of selective survival.
Keywords
Age Distribution, Age Factors, Aged, Cohort Studies, Educational Status, Female, Humans, Incidence, Income/statistics & numerical data, Life Style, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Socioeconomic Factors, Stroke/economics, Stroke/epidemiology, United States/epidemiology
Pubmed
Web of science
Open Access
Yes
Create date
18/10/2021 14:59
Last modification date
04/11/2021 7:40
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