Affiliation:
1. From the Department of Epidemiology (A.E., L.H.K., A.B.N.) University of Pittsburgh, Pa; the Department of Neurology (O.L.), University of Pittsburgh, Pa; the Department of Biostatistics (J.C.), University of Pittsburgh, Pa; Department of General Medicine (K.M.), University of Pittsburgh, Pa; the Department of Medicine (M.C.), University of Vermont, Colchester, Vt; and the Department of Biostatistics (R.K.), University of Washington, Seattle, Wash.
Abstract
Background and Purpose—
In the Cardiovascular Health Study (CHS), we previously observed lower stroke incidence in Allegheny County, PA compared with the other 3 study sites. The purpose of this study was to study possible reasons for the lower stroke incidence in Allegheny County.
Methods—
CHS participants 65 years or older who were stroke-free at baseline (n=5639) were followed between 1989 to 1990 and 2000 for the development of stroke. Risk factors at baseline and their subsequent control were compared among both groups. Site-specific hazard ratios for stroke incidence were calculated using Cox regression models.
Results—
The unadjusted hazard ratio for total stroke incidence in Forsyth County, NC; Sacramento County, CA; and Washington County, MD combined compared with Allegheny County, PA was 1.74 (95% CI: 1.42, 2.14). After adjustment for age and other traditional risk factors, there was modest reduction of the excess hazard in non-Allegheny sites compared with Allegheny County (hazard ratio=1.52, 95% CI: 1.17, 1.98). Between baseline and the seventh-year visits, control of hypertension, diabetes, lipids, smoking, atrial fibrillation and transient ischemic attack were similar across sites. White matter grade ≥3 on the baseline brain MRI was less common in Allegheny County (25.8% versus 36.3%, respectively;
P
<0.001) and accounted for 25% of the excess hazard in non-Allegheny sites compared with Allegheny County.
Conclusions—
Site differences in stroke risk factors at baseline and subsequent control only partially explain site differences in stroke incidence. White matter grade as a possible integrated measure of exposure and control of risk factors may help in explaining geographic variations in stroke incidence.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialised Nursing,Cardiology and Cardiovascular Medicine,Clinical Neurology
Cited by
14 articles.
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