Journal article
Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors
JAMA neurology, v 76(2)
01 Feb 2019
PMID: 30535250
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Race-specific and sex-specific stroke risk varies across the lifespan, yet few reports describe sex differences in stroke risk separately in black individuals and white individuals.
To examine incidence and risk factors for ischemic stroke by sex for black and white individuals.
This prospective cohort study included participants 45 years and older who were stroke-free from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, enrolled from the continental United States 2003 through 2007 with follow-up through October 2016. Data were analyzed from March 2018 to September 2018.
Sex and race.
Physician-adjudicated incident ischemic stroke, self-reported race/ethnicity, and measured and self-reported risk factors.
A total of 25 789 participants (14 170 women [54.9%]; 10 301 black individuals [39.9%]) were included. Over 222 120 person-years of follow-up, 939 ischemic strokes occurred: 159 (16.9%) in black men, 326 in white men (34.7%), 217 in black women (23.1%), and 237 in white women (25.2%). Between 45 and 64 years of age, white women had 32% lower stroke risk than white men (incidence rate ratio [IRR], 0.68 [95% CI, 0.49-0.94]), and black women had a 28% lower risk than black men (IRR, 0.72 [95% CI, 0.52-0.99]). Lower stroke risk in women than men persisted at age 65 through 74 years in white individuals (IRR, 0.71 [95% CI, 0.55-0.94]) but not in black individuals (IRR, 0.94 [95% CI, 0.68-1.30]); however, the race-sex interaction was not significant. At 75 years and older, there was no sex difference in stroke risk for either race. For white individuals, associations of systolic blood pressure (women: hazard ratio [HR], 1.13 [95% CI, 1.05-1.22]; men: 1.04 [95% CI, 0.97-1.11]; P = .099), diabetes (women: HR, 1.84 [95% CI, 1.35-2.52]; men: 1.13 [95% CI, 0.86-1.49]; P = .02), and heart disease (women: HR, 1.76 [95% CI, 1.30-2.39]; men, 1.26 [95% CI, 0.99-1.60]; P = .09) with stroke risk were larger for women than men, while antihypertensive medication use had a smaller association in women than men (women: HR, 1.17 [95% CI, 0.89-1.54]; men: 1.61 [95% CI, 1.29-2.03]; P = .08). In black individuals, there was no evidence of a sex difference for any risk factors.
For both races, at age 45 through 64 years, women were at lower stroke risk than men, and there was no sex difference at 75 years or older; however, the sex difference pattern may differ by race from age 65 through 74 years. The association of risk factors on stroke risk differed by race-sex groups. While the need for primordial prevention, optimal management, and control of risk factors is universal across all age, racial/ethnic, and sex groups, some demographic subgroups may require earlier and more aggressive strategies.
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Details
- Title
- Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors
- Creators
- Virginia J Howard - Department of Epidemiology, School of Public Health, University of Alabama at BirminghamTracy E Madsen - Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode IslandDawn O Kleindorfer - Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OhioSuzanne E Judd - Department of Biostatistics, School of Public Health, University of Alabama at BirminghamJ David Rhodes - Department of Biostatistics, School of Public Health, University of Alabama at BirminghamElsayed Z Soliman - Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston Salem, North CarolinaBrett M Kissela - Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OhioMonika M Safford - Department of Medicine, Weill-Cornell Medicine, New York, New YorkClaudia S Moy - Department of Health and Human Services, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MarylandLeslie A McClure - Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PennsylvaniaGeorge Howard - Department of Biostatistics, School of Public Health, University of Alabama at BirminghamMary Cushman - Department of Medicine, Larner College of Medicine, Colchester, Vermont
- Publication Details
- JAMA neurology, v 76(2)
- Publisher
- American Medical Association; United States
- Grant note
- K23 HL140081 / NHLBI NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000458357400010
- Scopus ID
- 2-s2.0-85058175737
- Other Identifier
- 991014877882604721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Clinical Neurology