Psychosocial Factors &Stroke Risk in a Biracial Population

DESCRIPTION (provided by applicant): Stroke mortality is the 3rd leading cause of death in the U.S. and a leading cause of long-term disability. Several stroke risk factors have been identified, but the role of psychosocial factors in stroke risk is poorly understood. Depressive symptoms, hostility, and stressful conditions are associated with cardiovascular diseases (CVD), but systematic investigation of these factors in relation to stroke incidence and mortality has been mostly lacking. We propose to conduct a prospective analysis of the relationship between psychosocial risk factors and stroke incidence and mortality, focusing on a comprehensive set of both well-established and novel psychosocial risk factors for CVD. We will examine these risk factors in a population-based study of older Blacks and (non-Hispanic) Whites. Blacks have almost double the risk of incident stroke compared with Whites and tend to have a significantly more adverse psychosocial risk profile. The proposed work will take advantage of existing data from the NIH-funded Chicago Health and Aging Project (CHAP;RO1 AG11101), an ongoing, longitudinal study of risk factors for Alzheimer's disease and age-related chronic conditions. Through the parent CHAP study, we have access to Medicare Claims files and mortality data to ascertain outcomes for the proposed study. This is an excellent opportunity to utilize a rich and unique data source to address important research questions on stroke risk in an at-risk population in a highly cost-effective manner. We propose 3 specific aims: 1) to determine whether psychosocial risk factors (depressive symptoms, perceived stress, hostility, and perceived discrimination) are associated with increased risk of incident stroke and stroke mortality;2) to determine whether living in stressful neighborhoods increases the likelihood of incident stroke and stroke mortality;and 3) to compare Blacks and Whites on risk for stroke and examine the degree to which racial differences in stroke risk are mediated by psychosocial risk factors. Secondarily, we will conduct sensitivity analyses to examine the association of psychosocial factors and risk of ischemic strokes, clinically diagnosed stroke from the subset of CHAP participants who have undergone detailed structured clinical interviews or MRI scans, and MRI-identified white matter hyperintensities and cortical and subcortical infarcts. The proposed study stands to identify potentially modifiable risk factors for stroke and thus has important potential for future efforts in stroke prevention.