Socioeconomic status and psychological stress: Examining intersection with race, sex and US geographic region in the REasons for Geographic and Racial Differences in Stroke study

Introduction: In the US, blacks are at higher risk of hypertension than whites. The single largest contributor to this disparity is the Southern Diet pattern. Inflammation biomarkers are associated with risk of hypertension, and C-reactive protein (CRP) is higher in blacks than whites. We studied whether elevated CRP in blacks relative to whites contributes to the racial disparity in hypertension in blacks. Methods: We included 6,548 black and white men and women age ≥45 years from the REGARDS cohort without hypertension at baseline ('03-'07) and who completed visit 2 in '13-'16. Incident hypertension was defined as BP ≥140/90 mm Hg or hypertension medication use at visit 2. Using logistic regression, the black:white odds ratio (OR) for incident hypertension was calculated adjusting for age, sex, race, and baseline SBP. We assessed the percent change in the black:white OR for incident hypertension after adding CRP. The 95% CI was calculated using 1,000 bootstrapped samples. We determined the impact of known hypertension risk factors and anti-inflammatory medications on the percent mediation by CRP. Results: Hypertension developed in 46% of blacks and 33% of whites. Adjusting for demographics, the black:white OR (95% CI) was 1.51, which was reduced to 1.46, a 9.3% reduction (95% CI 5.4%, 13.2%) by CRP (Table). In models including exercise, waist circumference, BMI, and depressive symptoms, the percent mediation by CRP was 3.7% (1.0%, 6.4%). Similar patterns were seen for models incorporating socioeconomic factors and medication use. After adding Southern diet pattern and dietary Na/K ratio, CRP no longer attenuated the association (1.3% mediation; -1.5, 4.1). Conclusions: CRP significantly attenuated the black-white difference in incident hypertension; however, once dietary factors were accounted for, CRP had no impact on the black:white difference in incident hypertension. Thus, inflammation as measured by CRP, may be part of the reason that dietary factors influence the black:white disparity in incident hypertension.

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Racial Differences in Mechanisms Linking Childhood Socioeconomic Status With Growth in Adult Body Mass Index: The Role of Adolescent Risk and Educational Attainment

Journal of Adolescent Health ◽

10.1016/j.jadohealth.2018.05.015 ◽

2018 ◽

Vol 63 (4) ◽

pp. 474-481

Author(s):

Amelia R. Gavin ◽

Tiffany M. Jones ◽

Rick Kosterman ◽

Jungeun Olivia Lee ◽

Christopher Cambron ◽

...

Keyword(s):

Body Mass Index ◽

Socioeconomic Status ◽

Educational Attainment ◽

Racial Differences ◽

Body Mass ◽

Adult Body Mass ◽

Adolescent Risk ◽

Adult Body ◽

Childhood Socioeconomic Status

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Premature Ventricular Complexes on Screening Electrocardiogram and Risk of Ischemic Stroke

Stroke ◽

10.1161/strokeaha.114.008447 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1365-1367 ◽

Cited By ~ 7

Author(s):

Sunil K. Agarwal ◽

Jennifer Chao ◽

Frederick Peace ◽

Suzanne E. Judd ◽

Brett Kissela ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Racial Differences ◽

Proportional Hazards Model ◽

Geographic Region ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Premature Ventricular Complexes ◽

Increased Risk

Background and Purpose— Premature ventricular complexes (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. Whether PVCs seen on routine ECG, commonly used in clinical practice, are associated with an increased risk of ischemic stroke remains unstudied. Methods— This analysis included 24 460 participants (aged, 64.5+9.3 years; 55.1% women; 40.0% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment. PVCs were ascertained from baseline ECG (2003–2007), and incident stroke cases through 2011 were confirmed by an adjudication committee. Results— A total of 1415 (5.8%) participants had at least 1 PVC at baseline, and 591 developed incident ischemic stroke during an average (SD) follow-up of 6.0 (2.0) years. In a cox proportional hazards model adjusted for age, sex, race, geographic region, education, previous heart disease, systolic blood pressure, blood pressure–lowering medications, current smoking, diabetes mellitus, left ventricular hypertrophy by ECG, and aspirin use and warfarin use, the presence of PVCs was associated with 38% increased risk of ischemic stroke (hazard ratio [95% confidence interval], 1.38 [1.05–1.81]). Conclusions— PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.

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N-terminal pro-B-type natriuretic peptide and microsize myocardial infarction risk in the reasons for geographic and racial differences in stroke study

BMC Cardiovascular Disorders ◽

10.1186/s12872-018-0806-4 ◽

2018 ◽

Vol 18 (1) ◽

Author(s):

Madeline R. Sterling ◽

Raegan W. Durant ◽

Joanna Bryan ◽

Emily B. Levitan ◽

Todd M. Brown ◽

...

Keyword(s):

Myocardial Infarction ◽

Racial Differences ◽

Natriuretic Peptide ◽

Stroke Study

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Abstract 17: Association of Race and Sex with Cardiovascular Disease and Non-Cardiovascular Disease Mortality: The REasons for Geographic and Racial Differences in Stroke study

Circulation ◽

10.1161/circ.135.suppl_1.17 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Gabriel S Tajeu ◽

Monika M Safford ◽

George Howard ◽

Rikki M Tanner ◽

Paul Muntner

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Racial Differences ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cvd Risk ◽

Hazard Ratios ◽

Stroke Study ◽

Cvd Mortality

Introduction: Black Americans have higher rates of cardiovascular disease (CVD) mortality compared with whites. Differences in sociodemographic, psychosocial, CVD, and other risk factors may explain increased mortality risk. Methods: We analyzed data from 29,015 REasons for Geographic and Racial Differences in Stroke study participants to determine factors that may explain the higher hazard ratio for CVD and non-CVD mortality in blacks compared with whites. Cause of death was adjudicated by trained investigators. Within age-sex sub-groups, we used Cox proportional hazards regression with progressive adjustment to estimate black:white hazard ratios. Results: Overall, 41.0% of participants were black, and 54.9% were women. Over a mean follow-up of 7.1 years (maximum 12.3 years), 5,299 participants died (1,797 CVD and 3,502 non-CVD deaths). Among participants < 65 years of age, the age and region adjusted black:white hazard ratio for CVD mortality was 2.28 (95% CI: 1.68-3.10) and 2.32 (95% CI: 1.80-3.00) for women and men, respectively, and for participants ≥ 65 was 1.54 (95% CI: 1.30-1.82) and 1.35 (95% CI: 1.16-1.57) for women and men, respectively ( Table ). The higher black:white hazard ratios for CVD mortality were no longer statistically significant after multivariable adjustment, with the largest attenuation occurring with sociodemographic and CVD risk factor adjustment. Among participants < 65 years of age, the age and region adjusted black:white hazard ratios for non-CVD mortality were 1.51 (95% CI: 1.24-1.85) and 1.76 (95% CI: 1.46-2.13) for women and men, respectively, and for participants ≥ 65 was 1.12 (95% CI: 1.00-1.26) and 1.34 (95% CI: 1.20-1.49) for women and men, respectively. The higher black:white hazard ratios for non-CVD mortality were attenuated after adjustment for sociodemographics. Conclusions: Black:white differences are larger for CVD than non-CVD causes of death. The increased CVD mortality for blacks compared with whites is primarily explained by sociodemographic and CVD risk factors.

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Abstract P153: Multiple Vulnerabilities to Health Disparities and Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke Study

Circulation ◽

10.1161/circ.141.suppl_1.p153 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Laura C Pinheiro ◽

Evgeniya Reshetnyak ◽

Madeline R Sterling ◽

Emily B Levitan ◽

Monika M Safford ◽

...

Keyword(s):

Heart Failure ◽

Health Disparities ◽

Social History ◽

Racial Differences ◽

Age Groups ◽

Cumulative Effect ◽

Annual Household Income ◽

Cox Models ◽

Stroke Study ◽

Increased Risk

Background: Multiple socially determined vulnerabilities (SDV) to health disparities often cluster within the same individual. Previous studies have shown that SDV are separately associated with increased risk of heart failure (HF). As there may be a cumulative effect of these SDVs in the same individual, understanding their joint impact on the incidence of HF is critical. Methods: REGARDS is a national prospective cohort study that recruited 30,239 adults <45 years of age from 2003-2007 with ongoing follow-up. We followed participants free of HF at baseline for incident HF hospitalization through December 31, 2016. Guided by the Healthy People 2020 framework, we examined 10 potential SDVs, retaining those that were associated with incident HF (p<0.10) and creating a count of SDV (0, 1, 2, 3+). We used Cox models to examine associations between the SDV count and incident HF, adjusting for potential confounders. Since disparities in HF have been shown to be greatest in younger individuals models were stratified by age. Results: The 25,790 participants were followed for a median of 10.1 years (IQR 6.5, 11.9); their mean age at baseline was 64.8, 55%% were women, and 40% were blacks. In age-adjusted models, Black race, low educational attainment, low annual household income, zip code poverty, poor public health infrastructure, and lack of health insurance were significantly associated with incident HF. In fully adjusted models, among those 45-64 years, compared to having no SDV, having a SDV was significantly associated with incident HF, with a trend toward a higher count conferring greater risk (Fig. 1). There was no association in other age groups. Conclusions: An increased number of SDVs was associated with risk of incident HF hospitalization among adults <65 years, even after adjustment for cardiovascular risk factors. Using a simple count of SDVs that could be incorporated into the social history during clinical assessment may identify younger individuals at increased risk of incident HF.

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