Socioeconomic factors elevate stroke risk in older Caribbean Hispanic population
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Black adults had the greatest incidence of stroke compared with Caribbean Hispanic and white adults up until age 75 years. But, by age 85 years, Caribbean Hispanic adults overtook the other groups, researchers reported.
Elevated risk for stroke among people of Caribbean Hispanic descent living in Northern Manhattan compared with their non-Hispanic white neighbors was likely due to socioeconomic disadvantage, according to findings presented at the International Stroke Conference.
The researchers reported that although black adults experienced the highest incidence rate of stroke (black adults, 13 per 1,000 person-years; Hispanic adults, 11 per 1,000 person-years; white adults, 8 per 1,000 person-years), by age 85 years, Caribbean Hispanic adults were found to be at the greatest risk for stroke. Overall, Hispanic adults had a 50% increased risk for stroke compared to white adults (adjusted HR = 1.5; 95% CI, 1.15-1.94).
Moreover, researchers attributed the rise in stroke risk in elderly Caribbean Hispanic adults to factors such as education and insurance status (HR after adjustment for education and insurance status = 1.15; 95% CI, 0.84-1.58). However, the risk for stroke remained significant for women of Caribbean Hispanic descent aged at least 70 years, according to the study.
“Our study provides novel insight into the relative risk of stroke among a Hispanic population that was primarily of Caribbean descent,” Hannah Gardener, ScD, epidemiologist and scientist in neurology at the University of Miami Miller School of Medicine, told Healio. “In this study population, Hispanic participants, primarily of Caribbean descent, had an increased risk of stroke as compared to non-Hispanic white participants, all residing in northern Manhattan. This increase is particularly strong among older women. Previous data had suggested that the ethnic disparity in stroke risk was strongest in middle age and dissipated in older ages. In our study, the findings contradict that belief and showed that race and ethnic disparities in stroke risk were persistent in the older age range.”
In other findings, black adults experienced a greater risk for stroke compared with white adults overall (aHR = 1.37; 95% CI, 1.02-1.84). According to the study, this disparity was driven by women aged at least 70 years (HR = 1.69; 95% CI, 1.05-2.73).
Overall, men had an elevated risk for stroke compared with women (aHR = 1.48; 95% CI, 1.21-1.81).
“Much of the increased stroke risk observed among Hispanic adults was explained by socioeconomic factors. When we adjusted for education and medical insurance, in the overall study, the increased risk among Caribbean Hispanic participants went away, which suggested that socioeconomic status explained a lot of the disparity,” Gardener told Healio. “When we looked at older women, though, we found that the ethnic disparity actually persisted even after adjusting for those proxy measures for socioeconomic status. However, among older women the increased risk of stroke observed among Hispanic participants did attenuate and became not significant after we adjusted for traditional stroke risk factors like smoking, high BP, cholesterol, diabetes, BMI, alcohol use and physical activity.”
Previous research
Researchers analyzed data from the Northern Manhattan Study of participants who were followed for an average of 13 years (mean age, 69 years; 37% men; 24% black; 21% white; 52% Hispanic), with the aim of assessing racial/ethnic disparities in prevalence for stroke.
“Previous studies on ethnic disparities in stroke risk in the U.S. have focused on Mexican Americans compared with non-Hispanic white adults,” Gardener said in an interview. “Those data have shown an increased risk for stroke among Mexican Americans, but we can’t necessarily generalize those findings to other Hispanic subgroups because of differences in health behaviors and vascular risk factors across the different subgroups.”
Larger cohorts needed
“Additional large studies are needed to better understand how race and ethnic disparities in stroke risk may vary across the ischemic stroke subtypes, and culturally tailored public health campaigns are needed to reduce the burden of stroke in the U.S., and particularly among minority populations at an increased risk,” Gardener said in an interview. – by Scott Buzby
Reference:
Gardener H, et al. Stroke. 2020;doi:10.1161/STROKEAHA.119.028806.
Gardener H, et al. Oral Presentation 90. Presented at: International Stroke Conference; Feb. 19-21, 2020; Los Angeles.
Disclosures: Gardener reports no relevant financial disclosures. Two other authors report financial ties with Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, LivaNova, Roche and UpToDate.