Table of Contents
Epidemiology Research International
Volume 2012, Article ID 481282, 7 pages
Research Article

Community Level Disadvantage and the Likelihood of First Ischemic Stroke

1Division of Social Epidemiology, Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY 10029, USA
2Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA
3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
4Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
5Departments of Neurology, Epidemiology, Human Genetics, Miller School of Medicine, University of Miami, FL 33136, USA
6Department of Biostatistics, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA

Received 13 April 2012; Revised 27 September 2012; Accepted 28 September 2012

Academic Editor: Demosthenes Panagiotakos

Copyright © 2012 Bernadette Boden-Albala et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background and Purpose. Residing in “disadvantaged” communities may increase morbidity and mortality independent of individual social resources and biological factors. This study evaluates the impact of population-level disadvantage on incident ischemic stroke likelihood in a multiethnic urban population. Methods. A population based case-control study was conducted in an ethnically diverse community of New York. First ischemic stroke cases and community controls were enrolled and a stroke risk assessment performed. Data regarding population level economic indicators for each census tract was assembled using geocoding. Census variables were also grouped together to define a broader measure of collective disadvantage. We evaluated the likelihood of stroke for population-level variables controlling for individual social (education, social isolation, and insurance) and vascular risk factors. Results. We age-, sex-, and race-ethnicity-matched 687 incident ischemic stroke cases to 1153 community controls. The mean age was 69 years: 60% women; 22% white, 28% black, and 50% Hispanic. After adjustment, the index of community level disadvantage (OR 2.0, 95% CI 1.7–2.1) was associated with increased stroke likelihood overall and among all three race-ethnic groups. Conclusion. Social inequalities measured by census tract data including indices of community disadvantage confer a significant likelihood of ischemic stroke independent of conventional risk factors.