Exploring psychosocial pathways between neighbourhood characteristics and stroke in older adults: the cardiovascular health study

Objectives: to investigate whether psychosocial pathways mediate the association between neighbourhood socioeconomic disadvantage and stroke. Methods: prospective cohort study with a follow-up of 11.5 years. Setting: the Cardiovascular Health Study, a longitudinal population-based cohort study of older adults >= 65 years. Measurements: the primary outcome was adjudicated incident ischaemic stroke. Neighbourhood socioeconomic status (NSES) was measured using a composite of six census-tract variables. Psychosocial factors were assessed with standard measures for depression, social support and social networks. Results: of the 3,834 white participants with no prior stroke, 548 had an incident ischaemic stroke over the 11.5-year follow-up. Among whites, the incident stroke hazard ratio (HR) associated with living in the lowest relative to highest NSES quartile was 1.32 (95% CI = 1.01-1.73), in models adjusted for individual SES. Additional adjustment for psychosocial factors had a minimal effect on hazard of incident stroke (HR = 1.31, CI = 1.00-1.71). Associations between NSES and stroke incidence were not found among African-Americans (n = 785) in either partially or fully adjusted models. Conclusions: psychosocial factors played a minimal role in mediating the effect of NSES on stroke incidence among white older adults.