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Determinants of Black-White Differences in the Risk of Cerebral Infarction: The National Health and Nutrition Examination Survey Epidemiologic Follow-up Study

Determinants of Black-White Differences in the Risk of Cerebral Infarction: The National Health... Abstract Objective: To determine whether blacks in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study remained at increased risk for cerebral infarction after adjusting for stroke risk factors and sociodemographic factors. Methods: A cohort study involving 8203 whites and 1362 blacks who participated in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. During the 13-year follow-up, 538 and 122 cerebral infarctions occurred in whites and blacks, respectively. Results: The black-white risk for cerebral infarction varied by age (P=.007 for race-age interaction). Compared with whites of the same age, blacks aged 35 to 44 years were at significantly increased risk for cerebral infarction (relative risk, 2.62; 95% confidence interval, 1.23 to 5.57), while older blacks, those older than 64 years, were not at increased risk (relative risk, 1.14; 95% confidence interval, 0.90 to 1.46). The relative risk for cerebral infarction decreased to 2.07 (95% confidence interval, 0.97 to 4.42) in younger blacks and 0.82 (95% confidence interval, 0.29 to 2.33) in older blacks after adjustment for age, sex, education, history of heart disease, diabetes, systolic blood pressure, treatment for hypertension, Quetelet index, and serum hemoglobin and magnesium levels. Conclusions: These results indicate that much of the increased risk for cerebral infarction experienced by blacks can be explained by their higher prevalence of stroke risk factors, especially diabetes, hypertension, and lower educational attainment. Younger blacks, however, may still be at increased risk after adjusting for stroke risk factors.(Arch Intern Med. 1995;155:1319-1324) References 1. Eckstrom PT, Brand FR, Edlavitch SA, Parish HM. Epidemiology of stroke in a rural area. Public Health Rep . 1969;84:878-882.Crossref 2. Heyman A, Karp HR, Heyden S, et al. Cerebrovascular disease in the biracial population of Evans County, Georgia. Stroke . 1971;2:509-518.Crossref 3. Peacock PB, Riley CP, Lampton TD, Raffel S, Walker JJ. The Birmingham Stroke, Epidemiology and Rehabilitation Study. In: Stewart GT, ed. Trends in Epidemiology: Application to Health Service Research and Training . Springfield, Ill: Charles C Thomas Publisher; 1972:231-245. 4. Gross CR, Kase CS, Mohr JP, Cunningham SC, Baker WE. Stroke in South Alabama: incidence and diagnostic features—a population based study. Stroke . 1984;15:249-255.Crossref 5. Report of the Secretary's Task Force on Black and Minority Health, Cardiovascular and Cerebrovascular Disease, Part 2 . Washington, DC: Dept of Health and Human Services; 1986;4:11-13. 6. Gillum RF. Stroke in blacks. Stroke . 1988;19:1-9.Crossref 7. Kittner SJ, White LR, Losonczy KG, Wolf PA, Hebel JR. Black-white difference in stroke incidence in a national sample: the contribution of hypertension and diabetes mellitus. JAMA . 1990;264:1267-1270.Crossref 8. National Center for Health Statistics. Plan and Operation of the Health and Nutrition Examination Survey, United States, 1971-1973: Part A—Development, Plan and Operation . Rockville, Md: Dept of Health Education and Welfare; 1977. US Dept of Health Education and Welfare publication (HRA) 77-310; Vital and Health Statistics, series 1, No. 10a. 9. National Center for Health Statistics. Plan and Operation of the Health and Nutrition Examination Survey, United States 1971-1973: Part B—Data Collection Forms of the Survey . Rockville, Md: Dept of Health Education and Welfare; 1977. US Dept of Health Education and Welfare publication (HRA) 77-1310; Vital and Health Statistics, series 1, No. 10b. 10. Plan and Operation of the NHANES I Augmentation Survey of Adults 25-74 years, United States, 1974-1975 . Rockville, Md: National Center for Health Statistics; 1978. Vital and Health Statistics, series 1, No. 10c. 11. Cornoni-Huntley J, Barbano HE, Brody JA, et al. National Health and Nutrition Examination I—Epidemiologic Follow-up Survey. Public Health Rep . 1983;98: 245-251. 12. Madans JH, Kleinman JC, Cox CS, et al. Ten years after NHANES: report of initial follow-up, 1982-1984. Public Health Rep . 1986;101:465-474. 13. Hadden W, Maurer K, Collins E, Stanton ES, Blodget D, Weinberger RM. Documentation for Medical History (Ages 12-72) Data Tape, Catalog Number 4081, Health and Nutrition Examination Survey 1971-1975 . Rockville, Md: National Center for Health Statistics; 1989. 14. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research . New York, NY: Van Nostrand Reinhold; 1982:351. 15. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med . 1993; 153:154-183.Crossref 16. Keil JE, Sutherland SE, Knapp RG, Lackland DT, Gazes PC, Tyroler HA. Mortality rates and risk factors for coronary disease in blacks as compared with white men and women. N Engl J Med . 1993;329:73-78.Crossref 17. Cooper RS, Ford E. Comparability of risk factors for coronary heart disease among blacks and whites in the NHANES-I Epidemiologic Follow-up Study. Ann Epidemiol . 1992;2:637-645.Crossref 18. Cooper RS, Ghali JK. Coronary heart disease: black-white differences. In: Saunders E, ed. Cardiovascular Disease in Blacks . Philadelphia, Pa: FA Davis Co; 1991:205-226. 19. Simmons BE, Castaner A, Campo A, Ferlinz J, Mar M, Cooper R. Coronary artery disease in blacks of lower socioeconomic status: angiographic findings from the Cook County Hospital Heart Disease Registry. Am Heart J . 116:1988: 90-97.Crossref 20. National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Arch Intern Med . 1993;153:186-208.Crossref 21. McMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease, I: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet . 1990;335: 765-774.Crossref 22. Davis CE, Rifkin BM, Brenner H, Gordon DJ. A single cholesterol measurement underestimates the risk of coronary heart disease, an empirical example from the Lipid Research Clinics Mortality Follow-up Study. JAMA . 1991;264: 3044-3046.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Determinants of Black-White Differences in the Risk of Cerebral Infarction: The National Health and Nutrition Examination Survey Epidemiologic Follow-up Study

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430120109013
Publisher site
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Abstract

Abstract Objective: To determine whether blacks in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study remained at increased risk for cerebral infarction after adjusting for stroke risk factors and sociodemographic factors. Methods: A cohort study involving 8203 whites and 1362 blacks who participated in the First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. During the 13-year follow-up, 538 and 122 cerebral infarctions occurred in whites and blacks, respectively. Results: The black-white risk for cerebral infarction varied by age (P=.007 for race-age interaction). Compared with whites of the same age, blacks aged 35 to 44 years were at significantly increased risk for cerebral infarction (relative risk, 2.62; 95% confidence interval, 1.23 to 5.57), while older blacks, those older than 64 years, were not at increased risk (relative risk, 1.14; 95% confidence interval, 0.90 to 1.46). The relative risk for cerebral infarction decreased to 2.07 (95% confidence interval, 0.97 to 4.42) in younger blacks and 0.82 (95% confidence interval, 0.29 to 2.33) in older blacks after adjustment for age, sex, education, history of heart disease, diabetes, systolic blood pressure, treatment for hypertension, Quetelet index, and serum hemoglobin and magnesium levels. Conclusions: These results indicate that much of the increased risk for cerebral infarction experienced by blacks can be explained by their higher prevalence of stroke risk factors, especially diabetes, hypertension, and lower educational attainment. Younger blacks, however, may still be at increased risk after adjusting for stroke risk factors.(Arch Intern Med. 1995;155:1319-1324) References 1. Eckstrom PT, Brand FR, Edlavitch SA, Parish HM. Epidemiology of stroke in a rural area. Public Health Rep . 1969;84:878-882.Crossref 2. Heyman A, Karp HR, Heyden S, et al. Cerebrovascular disease in the biracial population of Evans County, Georgia. Stroke . 1971;2:509-518.Crossref 3. Peacock PB, Riley CP, Lampton TD, Raffel S, Walker JJ. The Birmingham Stroke, Epidemiology and Rehabilitation Study. In: Stewart GT, ed. Trends in Epidemiology: Application to Health Service Research and Training . Springfield, Ill: Charles C Thomas Publisher; 1972:231-245. 4. Gross CR, Kase CS, Mohr JP, Cunningham SC, Baker WE. Stroke in South Alabama: incidence and diagnostic features—a population based study. Stroke . 1984;15:249-255.Crossref 5. Report of the Secretary's Task Force on Black and Minority Health, Cardiovascular and Cerebrovascular Disease, Part 2 . Washington, DC: Dept of Health and Human Services; 1986;4:11-13. 6. Gillum RF. Stroke in blacks. Stroke . 1988;19:1-9.Crossref 7. Kittner SJ, White LR, Losonczy KG, Wolf PA, Hebel JR. Black-white difference in stroke incidence in a national sample: the contribution of hypertension and diabetes mellitus. JAMA . 1990;264:1267-1270.Crossref 8. National Center for Health Statistics. Plan and Operation of the Health and Nutrition Examination Survey, United States, 1971-1973: Part A—Development, Plan and Operation . Rockville, Md: Dept of Health Education and Welfare; 1977. US Dept of Health Education and Welfare publication (HRA) 77-310; Vital and Health Statistics, series 1, No. 10a. 9. National Center for Health Statistics. Plan and Operation of the Health and Nutrition Examination Survey, United States 1971-1973: Part B—Data Collection Forms of the Survey . Rockville, Md: Dept of Health Education and Welfare; 1977. US Dept of Health Education and Welfare publication (HRA) 77-1310; Vital and Health Statistics, series 1, No. 10b. 10. Plan and Operation of the NHANES I Augmentation Survey of Adults 25-74 years, United States, 1974-1975 . Rockville, Md: National Center for Health Statistics; 1978. Vital and Health Statistics, series 1, No. 10c. 11. Cornoni-Huntley J, Barbano HE, Brody JA, et al. National Health and Nutrition Examination I—Epidemiologic Follow-up Survey. Public Health Rep . 1983;98: 245-251. 12. Madans JH, Kleinman JC, Cox CS, et al. Ten years after NHANES: report of initial follow-up, 1982-1984. Public Health Rep . 1986;101:465-474. 13. Hadden W, Maurer K, Collins E, Stanton ES, Blodget D, Weinberger RM. Documentation for Medical History (Ages 12-72) Data Tape, Catalog Number 4081, Health and Nutrition Examination Survey 1971-1975 . Rockville, Md: National Center for Health Statistics; 1989. 14. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research . New York, NY: Van Nostrand Reinhold; 1982:351. 15. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med . 1993; 153:154-183.Crossref 16. Keil JE, Sutherland SE, Knapp RG, Lackland DT, Gazes PC, Tyroler HA. Mortality rates and risk factors for coronary disease in blacks as compared with white men and women. N Engl J Med . 1993;329:73-78.Crossref 17. Cooper RS, Ford E. Comparability of risk factors for coronary heart disease among blacks and whites in the NHANES-I Epidemiologic Follow-up Study. Ann Epidemiol . 1992;2:637-645.Crossref 18. Cooper RS, Ghali JK. Coronary heart disease: black-white differences. In: Saunders E, ed. Cardiovascular Disease in Blacks . Philadelphia, Pa: FA Davis Co; 1991:205-226. 19. Simmons BE, Castaner A, Campo A, Ferlinz J, Mar M, Cooper R. Coronary artery disease in blacks of lower socioeconomic status: angiographic findings from the Cook County Hospital Heart Disease Registry. Am Heart J . 116:1988: 90-97.Crossref 20. National High Blood Pressure Education Program Working Group. National High Blood Pressure Education Program Working Group report on primary prevention of hypertension. Arch Intern Med . 1993;153:186-208.Crossref 21. McMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease, I: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet . 1990;335: 765-774.Crossref 22. Davis CE, Rifkin BM, Brenner H, Gordon DJ. A single cholesterol measurement underestimates the risk of coronary heart disease, an empirical example from the Lipid Research Clinics Mortality Follow-up Study. JAMA . 1991;264: 3044-3046.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 26, 1995

References