Race-Ethnic Disparities in the Impact of Stroke Risk Factors

Sacco, Ralph L.; Boden‐Albala, Bernadette; Abel, Gregory A.; Lin, I‐Feng; Elkind, Mitchell S.V.; Hauser, W. Allen; Paik, Myunghee Cho; Shea, Steven

doi:10.1161/01.str.32.8.1725

Cited by 343 publications

(279 citation statements)

References 41 publications

(25 reference statements)

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“…Although this study's findings could not establish a causal relationship between breastfeeding and risk of stroke, health disparities surrounding stroke1, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and breastfeeding rates52, 53, 54 persist. Stroke is 1 of the leading causes of death among Hispanic and non‐Hispanic black women over 65 2, 4.…”

Section: Discussioncontrasting

confidence: 62%

“…Stroke costs the nation $34 billion annually including the cost of healthcare services, medications, and lost productivity 1. Approximately 55 000 more US women than men suffer from a stroke annually 1, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Compared with elderly men, elderly female stroke survivors are also at increased risk for moderate to severe disability, poorer quality of life, and institutionalization 16, 17…”

Section: Introductionmentioning

confidence: 99%

“…Stroke is higher among Hispanics and non‐Hispanic blacks compared with non‐Hispanic whites 1, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 18. Hispanic and non‐Hispanic black women are at higher risk of stroke, partially due to increased rates of hypertension, obesity, diabetes mellitus, and physical inactivity,1, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 which are a few stroke risk factors.…”

Section: Introductionmentioning

confidence: 99%

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Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative

Jacobson

Hade

Collins

et al. 2018

JAHA

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BackgroundStroke is the third leading cause of death among US Hispanic and non‐Hispanic black women aged 65 and older. One factor that may protect against stroke is breastfeeding. Few studies have assessed the association between breastfeeding and stroke and whether this association differs by race and ethnicity.Methods and ResultsData were taken from the Women's Health Initiative Observational Study with follow‐up through 2010; adjusted hazard ratios for stroke subsequent to childbirth were estimated with Cox regression models accounting for left and right censoring, overall and stratified by race/ethnicity. Of the 80 191 parous women in the Women's Health Initiative Observational Study, 2699 (3.4%) had experienced a stroke within a follow‐up period of 12.6 years. The average age was 63.7 years at baseline. Fifty‐eight percent (n=46 699) reported ever breastfeeding; 83% were non‐Hispanic white, 8% were non‐Hispanic black, 4% were Hispanic, and 5% were of other race/ethnicity. After adjustment for nonmodifiable potential confounders, compared with women who had never breastfed, women who reported ever breastfeeding had a 23% lower risk of stroke (adjusted hazard ratio=0.77; 95% confidence interval 0.70‐0.83). This association was strongest for non‐Hispanic black women (adjusted hazard ratio=0.52; 95% confidence interval 0.37‐0.71). Further, breastfeeding for a relatively short duration (1‐6 months) was associated with a 19% lower risk of stroke (adjusted hazard ratios=0.81; 95% confidence interval 0.74‐0.89). This association appeared stronger with longer breastfeeding duration and among non‐Hispanic white and non‐Hispanic black women (test for trend P<0.01).ConclusionsStudy results show an association and dose‐response relationship between breastfeeding and lower risk of stroke among postmenopausal women after adjustment for multiple stroke risk factors and lifestyle variables. Further investigation is warranted.

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Section: Discussioncontrasting

confidence: 62%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative

Jacobson

Hade

Collins

et al. 2018

JAHA

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“…Many studies have examined the various risk factors for stroke and their prevalence and control among different racial ethnic groups. Blacks consistently have higher rates of hypertension [70][71][72]. The diabetes rate was alarmingly high among Native Americans (62%) [73].…”

Section: Effect Of Race Ethnicity On Outcomesmentioning

confidence: 99%

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

2011

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Stroke is the fourth killer and number one cause of adult disability in the United States. The estimated direct and indirect costs of stroke care in this country are $68.9 billion for 2009. The prevalence of stroke and its cost will undoubtedly rise as the aging population increases. In addition, stroke incidence and mortality are increasing in less developed countries in which the lifestyles and population restructuring are rapidly changing. More population-based research to assess incidence, risk factors, and outcomes are needed in these countries. Epidemiologic studies can help identify groups of individuals or regions at higher risk for stroke. They can also help us better understand the natural history of certain conditions and therefore push the direction of therapeutic investigations. Furthermore, the study of trends across different time periods and different populations can help investigators evaluate the effects of stroke care programs and treatment options.

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“…In the United States, stroke disproportionally affects minority populations 1, 2. Secondary prevention strategies in minority populations have been suboptimal due to cultural and behavioral factors not addressed in standard prevention modalities and poor integration into community resources 3, 4.…”

Section: Introduction and Rationalementioning

confidence: 99%

Discharge educational strategies for reduction of vascular events (DESERVE): design and methods

Lord

Carman

Roberts

et al. 2015

International Journal of Stroke

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RationaleStroke and vascular risk factors disproportionately affect minority populations, with Blacks and Hispanics experiencing a 2·5‐ and 2·0‐fold greater risk compared with whites, respectively. Patients with transient ischemic attacks and mild, nondisabling strokes tend to have short hospital stays, rapid discharges, and inaccurate perceptions of vascular risk.AimThe primary aim of the Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) trial is to evaluate the efficacy of a novel community health worker‐based multilevel discharge intervention vs. standard discharge care on vascular risk reduction among racially/ethnically diverse transient ischemic attack/mild stroke patients at one‐year postdischarge. We hypothesize that those randomized to the discharge intervention will have reduced modifiable vascular risk factors as determined by systolic blood pressure compared with those receiving usual care.Sample size estimatesGiven 300 subjects per group and alpha of 0·05, the power to detect a 6 mmHg reduction in systolic blood pressure is 89%.Design DESERVE trial is a prospective, randomized, multicenter clinical trial of a novel discharge behavioral intervention. Patients with transient ischemic attack/mild stroke are randomized during hospitalization or emergency room visit to intervention or usual care. Intervention begins prior to discharge and continues postdischarge.Study outcomesThe primary outcome is difference in systolic blood pressure reduction between groups at 12 months. Secondary outcomes include between‐group differences in change in glycated hemoglobin, smoking rates, medication adherence, and recurrent stroke/transient ischemic attack at 12 months.Discussion DESERVE will evaluate whether a novel discharge education strategy leads to improved risk factor control in a racially diverse population.

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Race-Ethnic Disparities in the Impact of Stroke Risk Factors

Cited by 343 publications

References 41 publications

Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative

Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative

Stroke Epidemiology: Advancing Our Understanding of Disease Mechanism and Therapy

Discharge educational strategies for reduction of vascular events (DESERVE): design and methods

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