Objective: Residence in a socioeconomically disadvantaged community is associated with mortality, but the mechanisms are not well understood. We examined whether socioeconomic features of the residential neighborhood contribute to poststroke mortality and whether neighborhood influences are mediated by traditional behavioral and biologic risk factors.Methods: We used data from the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults $65 years. Residential neighborhood disadvantage was measured using neighborhood socioeconomic status (NSES), a composite of 6 census tract variables representing income, education, employment, and wealth. Multilevel Cox proportional hazard models were constructed to determine the association of NSES to mortality after an incident stroke, adjusted for sociodemographic characteristics, stroke type, and behavioral and biologic risk factors.Results: Among the 3,834 participants with no prior stroke at baseline, 806 had a stroke over a mean 11.5 years of follow-up, with 168 (20%) deaths 30 days after stroke and 276 (34%) deaths at 1 year. In models adjusted for demographic characteristics, stroke type, and behavioral and biologic risk factors, mortality hazard 1 year after stroke was significantly higher among residents of neighborhoods with the lowest NSES than those in the highest NSES neighborhoods (hazard ratio 1.77, 95% confidence interval 1.17-2.68).Conclusion: Living in a socioeconomically disadvantaged neighborhood is associated with higher mortality hazard at 1 year following an incident stroke. Further work is needed to understand the structural and social characteristics of neighborhoods that may contribute to mortality in the year after a stroke and the pathways through which these characteristics operate. Neurology â 2013;80:520-527 GLOSSARY CHS 5 Cardiovascular Health Study; CI 5 confidence interval; CVD 5 cardiovascular disease; DBP 5 diastolic blood pressure; HDL 5 high-density lipoprotein; HR 5 hazard ratio; IRB 5 institutional review board; NSES 5 neighborhood socioeconomic status; SBP 5 systolic blood pressure; SES 5 socioeconomic status; TC 5 total cholesterol.Stroke is a leading cause of death in the United States. Among adults ages 65 years and older, mortality at 1 year after an initial stroke is over 30%.1 An emerging literature suggests that place of residence may play an important role in stroke risk.2-8 Recent evidence suggests that the association between neighborhood socioeconomic status (SES) and incident stroke is mediated by biologic risk factors, such as control of blood pressure, blood sugars, and lipids. 4 Fewer studies have explored whether neighborhood factors influence poststroke mortality, 2,9,10 and although socioeconomic features of neighborhoods, such as area-level deprivation 2,10 and neighborhood social cohesion, 9 have been implicated in poststroke mortality, the mechanisms remain poorly understood. To examine the relationship between neighborhood SES (NSES) and mortality after stroke and whether t...

Background and Purpose Neighborhood characteristics may influence the risk of stroke and contribute to socioeconomic disparities in stroke incidence. The objectives of this study were to examine the relationship between neighborhood socioeconomic status (NSES) and incident ischemic stroke and examine potential mediators of these associations. Methods We analyzed data from 3834 whites and 785 African Americans enrolled in the Cardiovascular Health Study, a multicenter, population-based, longitudinal study of adults ages ≥65 years from four U.S. counties. The primary outcome was adjudicated incident ischemic stroke. NSES was measured using a composite of six census tract variables. Race-stratified multilevel Cox proportional hazard models were constructed, adjusted for sociodemographic, behavioral, and biologic risk factors. Results Among whites, in models adjusted for sociodemographic characteristics, stroke hazard was significantly higher among residents of neighborhoods in the lowest compared to the highest NSES quartile (Hazard Ratio [HR] =1.32; 95% CI 1.01-1.72), with greater attenuation of the HR after adjustment for biologic risk factors (HR=1.16; 0.88-1.52) than for behavioral risk factors (HR=1.30; 0.99-1.70). Among African Americans, we found no significant associations between NSES and ischemic stroke. Conclusions Higher risk of incident ischemic stroke was observed in the most disadvantaged neighborhoods among whites, but not among African Americans. The relationship between NSES and stroke among whites appears to be mediated more strongly by biologic than behavioral risk factors.