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Stroke. 2011 May;42(5):1212-7. doi: 10.1161/STROKEAHA.110.609164. Epub 2011 Apr 14.
Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence.
Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence.
Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5).
Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.
社会凝聚力与冠心病发病率呈负相关，但它与中风风险的关系尚未得到研究。本研究旨在探讨邻里社会凝聚力是否对中风死亡率有保护作用。
数据来自一项老年人慢性病纵向研究中的 5789 名参与者（60%为女性，62%为黑人，平均年龄 74.7 岁）。通过国家死亡索引确定 2007 年 12 月 31 日之前的中风死亡率，在 11 年的随访期间，共发现 186 例中风死亡。在有医疗保险索赔文件链接的子样本中确定中风发病率（N=3816），共发现 701 例首次中风。通过 6 项评估与邻居接触和社交互动频率的项目来衡量凝聚力；项目的得分进行了标准化处理，并取平均值。个体得分在 82 个普查块组中进行平均，形成邻里社会凝聚力的衡量标准。边际 Cox 比例风险模型检验了邻里层面凝聚力与中风死亡率和发病率之间的关系。
凝聚力每增加 1 分，中风死亡率降低 53%（风险比，0.47；95%可信区间，0.24 至 0.90），调整了相关协变量，包括社会人口统计学、已知中风风险因素和邻里层面的社会经济地位。种族与凝聚力的交互作用（P=0.04）表明，凝聚力对白人有保护作用（风险比，0.34；95%可信区间，0.17 至 0.67），但对黑人没有保护作用（风险比，1.17；95%可信区间，0.35 至 3.86）。凝聚力与中风发病率无关（P>0.5）。
邻里层面的社会凝聚力对中风死亡率有独立的保护作用。需要进一步研究观察到的种族差异以及凝聚力对健康的保护机制。
