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. 1. Introduction Stroke continues to burden health systems in all countries. Much work has clarified key biological risk factors including hypertension, diabetes, and coronary artery disease as well as lifestyle factors including smoking, diet, and physical activity. Increasingly epidemiology has investigated measures of socioeconomic status (SES) including education, income, and occupation and indeed a number of papers have documented associations between SES and overall and disease-specific morbidity and mortality, including stroke [1–13]. SES may be a major contributor to race/ethnic and other disparities. A recent paper suggested that only 50% of the black-white stroke disparity is explained by biologic risk factors and measures of individual SES [3]. Beyond individual measures of SES, area measures of SES may contribute to rates of disease [4, 10, 11]. However, little work has investigated the association between area measures of SES controlling for individual measures of SES. Area level SES may be an important contributor to stroke disparities including by race/ethnicity. In this analysis, we sought to
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