Abstract 52: Contributors to the Rural Excess in Stroke Mortality: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Dawn O Kleindorfer ◽  
D. L Long ◽  
Mary Cushman ◽  
Virginia J Howard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Rural Regions ◽  
Stroke Incidence ◽  
Regards Study ◽  
The Impact

Introduction: One NIH goal is to investigate the US nationwide rural-urban health disparities; however, few studies provide data to help understand the 30% higher rural stroke mortality. It is unknown if the higher stroke mortality is attributable to a higher incidence of stroke, or to a higher case fatality, in rural regions. Further, the role of risk factors or SES status in higher incidence or case-fatality is unknown. Methods: REGARDS participants stroke-free at baseline (n = 25,090) were stratified by Rural-Urban Commuting Area strata: urban, large rural city/town, or small rural town or isolated region. Participants were followed for incident stroke, and case fatality was defined as death within 30-days of a stroke. Difference in incident stroke was assessed using proportional hazards analysis, and case-fatality by logistic regression, each considered after adjustment for demographic factors, further adjustment for risk factors, and further adjustment for SES. Results: Over an average follow-up of 8.2 years, 1,060 incident strokes occurred, of which 160 died within 30 days. Risk of incident stroke increased with rurality (p = 0.016), with a hazard 1.21-times (95% CI: 1.00 - 1.46) higher in large rural cities/towns, and 1.24-times (95% CI: 1.00 - 1.54) higher in small rural towns or isolated regions (see table). Adjustment for risk factors and SES attenuated the estimated risk by 50%, and the association became non-significant. There was no evidence of a higher case-fatality from stroke in rural regions (p > 0.46). Discussion: The higher stroke mortality in rural regions appears to be attributable to higher stroke incidence, and not to higher case-fatality. Higher stroke incidence in rural regions is partially attributable to a worse risk factor profile and lower SES. Efforts to reduce rural disparity in stroke mortality should focus on preventive strategies, especially those relevant to risk factor development and control, and/or mitigating the impact of lower SES.

Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Audrey L Austin ◽  
Michael G Crowe ◽  
Martha R Crowther ◽  
Virginia J Howard ◽  
Abraham J Letter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Racial Differences ◽  
Stroke Risk ◽  
Depression Scale ◽  
Stroke Incidence ◽  
Blacks And Whites ◽  
The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

Abstract 84: Where Should Interventions be Focused to Reduce the Black-white Disparity in Stroke Mortality? Insights From the Reasons For Geographic And Racial Differences In Stroke (REGARDS) Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Claudia S Moy ◽  
Virginia J Howard ◽  
Leslie A McClure ◽  
Dawn O Kleindorfer ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Racial Differences ◽  
Proportional Hazards ◽  
Case Fatality ◽  
Major Contributor ◽  
Stroke Mortality ◽  
Stroke Event ◽  
Stroke Incidence ◽  
Fatal Stroke ◽  
Initial Event

Introduction: The study of racial disparities in stroke mortality should guide interventions to reduce these disparities. A higher mortality in blacks than whites could result from a higher incidence of stroke in blacks, a higher case-fatality of stroke in blacks, or both. Interventions focusing on primary prevention are needed if incidence is a major contributor to disparities, while interventions addressing treatment are a priority if case-fatality is a major contributor. Hypothesis: Higher stroke mortality in REGARDS will be attributable to higher incidence, higher case fatality, or both. Methods: 29,681 black and white participants aged 45+ were followed for stroke over 7 years. Fatal stroke (stroke mortality) was defined as a stroke event with death within 30-days, incident stroke included all stroke events (regardless of death), and case-fatality as the proportion of stroke events with death within 30-days. Black-white differences in stroke mortality and stroke incidence were assessed using proportional hazards models, and case-fatality using logistic regression (with adjustment for age and sex). Results: There were 954 incident events with 242 deaths within 30-days. We showed higher stroke mortality in blacks, with a black-white disparity in fatal stroke at young ages (at age 45, HR = 4.35; 95% CI: 1.94-9.76), but a declining magnitude of the disparity at older ages (at age 85, HR = 0.87; 95% CI: 0.56 - 1.35). The pattern was similar for incident stroke, although the magnitude of the black-white disparity was smaller (at age 45: HR = 2.40; 95% CI: 1.72 - 3.33; at age 85: HR = 0.95; 95% CI: 0.76 - 1.19). There was no evidence of a black-white disparity in case-fatality rate (OR = 1.26; 95% CI: 0.93 - 1.71). Conclusion: In a nationwide cohort, we found that the black-white disparity in stroke mortality was primarily attributable to a racial disparity in stroke incidence, not case fatality. Thus, interventions designed to reduce the black-white disparity in stroke mortality require a primary prevention focus aimed at reducing the disparity in stroke incidence. While effective interventions to improve stroke outcomes are needed, these data suggest that improving treatment after the initial event will not reduce black-white disparities in stroke mortality.

Abstract WP158: Case Fatality and Risk Factor Trend Contributions to Stroke Mortality in Non-Hispanic Blacks and Non-Hispanic Whites, 1999-2012

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Joanne Penko ◽  
Andrew E Moran ◽  
Antoinette Mason ◽  
Pamela G Coxson ◽  
Mark J Pletcher ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Factor ◽  
Racial Differences ◽  
Density Lipoprotein ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Mortality Trends ◽  
Stroke Risk Factor ◽  
Stroke Incidence ◽  
Policy Model

Introduction: Stroke death rates have declined nationally, but less in men and non-Hispanic Blacks. We quantified case-fatality and risk factor trend contributions to non-Hispanic Black and non-Hispanic White 1999-2012 stroke mortality trends. Methods: The CVD Policy Model is a computer simulation of heart disease and stroke incidence, prevalence, and mortality in US adults ≥ 35 years old. We modeled mean systolic blood pressure (SBP), low-density lipoprotein (LDL), and body mass index (BMI), prevalence of diabetes and smoking, and case fatality for 1999-2002, 2003-06, and 2007-12 by sex and race (NHANES; NHDS) to predict stroke mortality trends and these predictions were compared with observed data (CDC Wonder; ICD-10 I60-69). We then simulated the effects of isolated risk factors on stroke mortality in younger (age 35-64 years) and older (age 65-84 years) men and women. Results: Model predictions mirrored observed trends for stroke mortality in Whites (men: predicted -27.0% v. observed -29.2%; women: -34.8% v. -33.3%) and Blacks (men: -23.8% v. -22.2%; women: -31.0% v. -30.0%). Case fatality was the main contributor to the observed decrease in stroke mortality (approximately -25%) but did not explain differences between race groups. Combined risk factor trends contributed to decreased mortality in women (-12.8% in Whites; -8.7% in Blacks), but not men. Decreased mean SBP contributed in all women (-10.7% to -12.6%, depending on age/race) and older men (-4.0%), but not young men. Increased diabetes prevalence offset improvements in stroke mortality in older White men (+2.5%), younger Blacks (men: +4.0, women: +1.5%) and, to a larger degree, older Blacks (men: +9.9%, women: +5.6% ). Conclusions: Reduced case fatality was the strongest driver of decreased stroke mortality from 1999-2012 overall, while risk factor trends explained gender and race differences. Targeting high blood pressure in young adult men and preventing diabetes at all ages could further decrease stroke mortality and reduce racial differences. Blacks would benefit most from more aggressive stroke risk factor control.

Abstract 88: Social Inequalities in Stroke Mortality, Incidence and Case-fatality in Europe.

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Marco M Ferrario ◽  
Giovanni Veronesi ◽  
Kari Kuulasmaa ◽  
Martin Bobak ◽  
Lloyd E Chambless ◽  
...  
Keyword(s):  
Risk Factors ◽  
Social Inequalities ◽  
Cox Regression ◽  
Case Fatality ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Low Education ◽  
Mortality Incidence ◽  
European Populations

Introduction and aim: There are limited comparative data on social inequalities in stroke morbidity across Europe. We aimed to assess the magnitude of educational class inequalities in stroke mortality, incidence and 1-year case-fatality in European populations. Methods: The MORGAM study comprised 45 cohorts from Finland, Denmark, Sweden, Northern Ireland, Scotland, France, Germany, Italy, Lithuania, Poland and Russia, mostly recruited in mid 1980s-early 90s. Baseline data collection and follow-up (median 12 years) for fatal and non-fatal strokes adhered to MONICA-like procedures. Stroke mortality was defined according to the underlying cause of death (ICD-IX codes 430-438 or ICD-X I60-I69). We derived 3 educational classes from population-, sex- and birth year-specific tertiles of years of schooling. We estimated the age-adjusted difference in event rates, and the age- and risk factor-adjusted hazard ratios (HRs), between the bottom and the top of the educational class distribution from sex- and population-specific Poisson and Cox regression models, respectively. The association between 1-year case-fatality and education was estimated through logistic models adjusted for risk factors. Results: Among the 91,563 CVD-free participants aged 35-74 at baseline, 1037 stroke deaths and 3902 incident strokes occurred during follow-up. Low education accounted for 26 additional stroke deaths per 100,000 person-years in men (95%CI: 9 to 42), and 19 (7 to 32) in women. In both genders, inequalities in fatal stroke rates were larger in the East EU and in the Nordic Countries populations. The age-adjusted pooled HRs of first stroke, fatal or non-fatal, for the least educated men and women were 1.52 (95%CI: 1.29-1.78) and 1.51 (1.25-1.81), respectively, consistently across populations. Adjustment for smoking, blood pressure, HDL-cholesterol and diabetes attenuated the pooled HRs to 1.34 (95%CI: 1.14-1.57) in men and 1.29 (1.07-1.55) in women. A significant association between low education and increased 1-year case-fatality was observed in Northern Sweden only. Conclusions: Social inequalities in stroke incidence are widespread in most European populations, and less than half of the gap is explained by major risk factors.

Abstract TP196: New Zealand Workforce Stroke Incidence: Urban and Rural Risk Factor Evaluation

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hope E Buell ◽  
Patricia Metcalf ◽  
Daniel Exeter
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Smoking Status ◽  
Prior History ◽  
Stroke Incidence ◽  
Stroke Outcomes ◽  
The Impact

This analysis aims to assess the impact of urban and rural risk factors on a model of stroke incidence in a New Zealand workforce population. The New Zealand study consisted of 4,926 subjects prospectively enrolled at 46 worksites. The subjects were aged 40-78 years at baseline and had no prior history of stroke. This prospective study defines stroke events experienced by the study subjects during follow-up between 1988 and 2012 based on hospital admission coding. Proportional hazards regression models were fit using baseline characteristics. The difference in stroke outcomes for urban and rural worksites was also evaluated. Results demonstrate that baseline demographic, physical exam, and behavioural measures impact stroke outcomes. While the baseline distribution of stroke risk factors such as Pacific Island ethnicity, smoking status, and increased blood pressure indicates a potentially higher risk of stroke in the rural population, the proportional hazards model does not identify increased stroke risk for rural workers. Additional analysis of the diet, exercise and Quality of Life measures for these subjects may provide further information into the stroke risk profiles of individuals working in different locales.

scholarly journals The impact of risk factor trends on intracerebral hemorrhage incidence over the last two decades—The Tromsø Study

2018 ◽  
Vol 14 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Maria Carlsson ◽  
Tom Wilsgaard ◽  
Stein Harald Johnsen ◽  
Liv-Hege Johnsen ◽  
Maja-Lisa Løchen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Intracerebral Hemorrhage ◽  
Proportional Hazards ◽  
Temporal Trends ◽  
Population Based ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Intracerebral Hemorrhages ◽  
The Impact

Background Studies on the relationship between temporal trends in risk factors and incidence rates of intracerebral hemorrhage are scarce. Aims To analyze temporal trends in risk factors and incidence rates of intracerebral hemorrhage using individual data from a population-based study. Methods We included 28,167 participants of the Tromsø Study enrolled between 1994 and 2008. First-ever intracerebral hemorrhages were registered through 31 December 2013. Hazard ratios (HRs) for intracerebral hemorrhage were analyzed by Cox proportional hazards models, risk factor levels over time by generalized estimating equations, and incidence rate ratios (IRR) by Poisson regression. Results We registered 219 intracerebral hemorrhages. Age, male sex, systolic blood pressure (BP), diastolic BP, and hypertension were associated with intracerebral hemorrhage. Hypertension was more strongly associated with non-lobar intracerebral hemorrhage (HR 5.08, 95% CI 2.86–9.01) than lobar intracerebral hemorrhage (HR 1.91, 95% CI 1.12–3.25). In women, incidence decreased significantly (IRR 0.46, 95% CI 0.23–0.90), driven by a decrease in non-lobar intracerebral hemorrhage. Incidence rates in men remained stable (IRR 1.27, 95% CI 0.69–2.31). BP levels were lower and decreased more steeply in women than in men. The majority with hypertension were untreated, and a high proportion of those treated did not reach treatment goals. Conclusions We observed a significant decrease in intracerebral hemorrhage incidence in women, but not in men. A steeper BP decrease in women may have contributed to the diverging trends. The high proportion of untreated and sub-optimally treated hypertension calls for improved strategies for prevention of intracerebral hemorrhage.

Abstract 2535: Urban Versus Rural Differences In Stroke Risk: The CDC Wonder Estimates Of Mortality, And REasons For Geographic And Racial Differences In Stroke (REGARDS) Estimates Of Incidence And Survival After Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
George Howard ◽  
Michael Mullen ◽  
John Higginbotham ◽  
Dawn O Kleindorfer ◽  
Leslie A McClure ◽  
...  
Keyword(s):  
Racial Differences ◽  
Stroke Risk ◽  
Classification Scheme ◽  
Statistical Significance ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Risk Of Death ◽  
Urban Rural ◽  
Regards Study

Introduction: Rural-urban disparities in stroke are poorly understood and incompletely characterized. US stroke incidence, mortality, and survival after stroke have not, to our knowledge, been previously reported by urban-rural status. Methods: Data for US residents over age 45 from the CDC WONDER system were used to describe the age-adjusted stroke mortality rates between 1999 and 2007 for each county in the US, stratified by rurality. Stroke was defined by ICD-10 codes 60-69. Rurality was defined at the county level using the National Center for Health Statistics 6-level classification scheme. Data from the REGARDS Study, a longitudinal cohort study of 30,239 black and white participants aged 45+ from 48 states, were used to estimate the age and sex adjusted hazard ratio for incident stroke, and to assess survival after stroke, using the same urban/rural classification scheme. Results: Between 1999 and 2007, stroke mortality (per 100,000) for those aged 45+ was higher in rural counties for both whites and blacks, with a 20% difference in whites (156.6 for rural versus 131.0 for central metropolitan) and a 32% difference in blacks (237.4 versus 179.6). Among 27,740 REGARDS participants who were stroke-free at baseline with follow-up data, 614 adjudicated stroke events occurred over a mean 4.9 years of follow-up. For whites, incident stroke risk did not change with higher urbanization (HR reported in table ). There was a consistently lower risk of incident stroke with higher urbanization for blacks although this difference did not reach statistical significance (see table ). Follow-up was available on 609 of the stroke events. Risk of death after stroke appeared consistently (although generally non-significantly) lower with greater urbanization (see table ) for both blacks and whites. Discussion: Greater urbanization appears to be associated with lower stroke mortality for both whites and blacks, although differences may be larger for blacks. This difference in mortality may be due to both decreased incidence and survival following stroke for blacks; however, higher mortality for rural whites appears to be only due to decreased survival. Reasons for differences in incidence and survival following stroke may be related to control of vascular risk factors and access to care although further study is required.

scholarly journals Incidence and Case Fatality at the County Level as Contributors to Geographic Disparities in Stroke Mortality

2016 ◽  
Vol 47 (2) ◽  
pp. 96-102 ◽  
Author(s):  
Darwin R. Labarthe ◽  
George Howard ◽  
Monika M. Safford ◽  
Virginia J. Howard ◽  
Suzanne E. Judd ◽  
...  
Keyword(s):  
Racial Differences ◽  
Stroke Prevention ◽  
Case Fatality ◽  
Stroke Care ◽  
The United States ◽  
Hazard Ratio ◽  
Mortality Data ◽  
Stroke Mortality ◽  
Stroke Incidence ◽  
Stroke Case

Background: Is the high stroke mortality in the Southeastern parts of the United States driven by differences in stroke incidence or case-fatality? This question remains unanswered. Differences in incidence would underscore the need for stroke prevention, while differences in case fatality would call for improved stroke care. Methods: Quartiles of US counties were defined by stroke mortality, and this gradient was related with stroke incidence and stroke case fatality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, where 1,317 incident stroke events (of which 242 were fatal) occurred among 29,650 participants. Results: There was a significant (p = 0.0025) gradient of fatal stroke events in REGARDS (quartile 4 vs. quartile 1 (Q4/Q1) hazard ratio 1.95, 95% CI 1.35-2.81), demonstrating the consistency of REGARDS with national mortality data. The gradient for incident stroke (fatal + nonfatal) was also significant (p = 0.0023; Q4/Q1 hazard ratio 1.29, 95% CI 1.10-1.52). The gradient for stroke case-fatality was marginally significant (p = 0.058), though the OR for Q4/Q1 (1.71, 95% CI 1.13-2.25) was large. Conclusions: Both stroke incidence and case-fatality in REGARDS appear to be contributing, underscoring the need for strengthening both stroke prevention and acute stroke care in order to reduce the disparity.

Abstract P28: Awareness and Management of CVD Risk Factors and Area-Level Mortality Regions in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Monika M Safford ◽  
Gaurav Parmar ◽  
Todd M Brown ◽  
Martha Hovater ◽  
David Roth ◽  
...  
Keyword(s):  
Risk Factors ◽  
Racial Differences ◽  
Community Dwelling ◽  
Stroke Mortality ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
National Cohort ◽  
Urban Rural ◽  
Regards Study ◽  
And Control

Background: Federally designated Health Professional Shortage Areas (HPSA) receive extra resources, but recent reports suggest that HPSAs may not consistently identify areas of need. We examined an alternative approach to designating areas of need based on county-level ischemic heart disease (IHD) and stroke mortality rates. Methods: We examined participants in the REGARDS Study, a national cohort of 30,239 US community-dwelling adults (42% African Americans) aged ≥45 recruited 2003-7. “Need” was defined by awareness, treatment or control of hypertension (n=21,118), diabetes (6,355) or hyperlipidemia (21,096). Awareness and treatment were self-reported, and control was defined as BP <140/90 mmHg (<130/80 for diabetes or chronic kidney disease) for hypertension; fasting blood sugar <140 mg/dL (<200 if non-fasting) for diabetes; and LDL cholesterol <130 mg/dL for hyperlipidemia. Each county was categorized into race-specific tertiles of IHD and, separately, stroke mortality, using 1999-2006 CDC data (based on death certificates). Sociodemographics, health behaviors, physical functioning and insurance status were included in separate multivariable models describing the relationships between IHD and stroke mortality and each element of need. Results: Participants resided in 1821 US counties, 578 in the lowest IHD mortality tertile (597 for stroke), 628 in the medium (586), and 627 in the highest (638). Awareness and treatment of CVD risk factors were similar for residents in counties across IHD and stroke mortality tertiles, but control tended to be lower in counties in the highest mortality tertiles (Table). Conclusions: Research is needed to elucidate why some CVD risk factor control is worse in areas of high CVD mortality despite similar levels of awareness or treatment of disease between high and low mortality areas. High stroke and IHD mortality may be one way to designate areas of need for resource allocation… Table. Adjusted * OR (95% CI) for Residence in a County in the Highest vs. Lowest (ref) IHD and Stroke Mortality Tertiles, ** for Awareness, Treatment, and Control of Hypertension, Diabetes and Hyperlipidemia. Outcome Hypertension Diabetes Hyperlipidemia IHD Stroke IHD Stroke IHD Stroke Awareness 1.14 (0.97,1.35) 1.07 (0.90,1.28) 1.02 (0.78,1.34) 0.98 (0.73,1.31) 1.05 (0.94,1.17) 0.98 (0.87,1.10) Treatment 1.10 (0.85,1.43) 0.80 (0.61,1.04) 1.21 (0.96,1.52) 1.12 (0.88,1.42) 1.06 (0.94,1.20) 1.02 (0.90,1.15) Control 1.00 (0.89,1.12) 0.88 (0.78,0.99) 0.79 (0.64,0.96) 0.82 (0.64,1.05) 0.83 (0.70,0.98) 0.95 (0.80,1.14) * Adjusted for age, race, gender, education, income, urban/rural residence, alcohol/tobacco use, medication adherence, exercise, BMI, and functional status. ** Race-specific tertiles.

scholarly journals High sodium:potassium intake ratio increases the risk for all-cause mortality: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study

2013 ◽  
Vol 2 ◽  
Author(s):  
Suzanne E. Judd ◽  
Kristal J. Aaron ◽  
Abraham J. Letter ◽  
Paul Muntner ◽  
Nancy S. Jenny ◽  
...  
Keyword(s):  
Racial Differences ◽  
Proportional Hazards ◽  
Reference Group ◽  
Cox Proportional Hazards ◽  
Stroke Incidence ◽  
Black And White ◽  
Cox Proportional Hazards Models ◽  
Group Data ◽  
All Cause Mortality ◽  
Regards Study

AbstractIncreased dietary Na intake and decreased dietary K intake are associated with higher blood pressure. It is not known whether the dietary Na:K ratio is associated with all-cause mortality or stroke incidence and whether this relationship varies according to race. Between 2003 and 2007, the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort enrolled 30 239 black and white Americans aged 45 years or older. Diet was assessed using the Block 98 FFQ and was available on 21 374 participants. The Na:K ratio was modelled in race- and sex-specific quintiles for all analyses, with the lowest quintile (Q1) as the reference group. Data on other covariates were collected using both an in-home assessment and telephone interviews. We identified 1779 deaths and 363 strokes over a mean of 4·9 years. We used Cox proportional hazards models to obtain multivariable-adjusted hazard ratios (HR). In the highest quintile (Q5), a high Na:K ratio was associated with all-cause mortality (Q5 v. Q1 for whites: HR 1·22; 95 % CI 1·00, 1·47, P for trend = 0·084; for blacks: HR 1·36; 95 % CI 1·04, 1·77, P for trend = 0·028). A high Na:K ratio was not significantly associated with stroke in whites (HR 1·29; 95 % CI 0·88, 1·90) or blacks (HR 1·39; 95 % CI 0·78, 2·48), partly because of the low number of stroke events. In the REGARDS study, a high Na:K ratio was associated with all-cause mortality and there was a suggestive association between the Na:K ratio and stroke. These data support the policies targeted at reduction of Na from the food supply and recommendations to increase K intake.

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