From the Division of General Medicine and HSR&D Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (D.A.L., K.M.L.); and Stroke Program (D.A.L., L.B.M., L.E.S., M.A.S., L.D.L.), Department of Epidemiology (L.B.M., L.D.L.), Institute for Social Research (K.M.L.), University of Michigan, Ann Arbor, MI.
Stroke. 2013 Nov;44(11):3243-5. doi: 10.1161/STROKEAHA.113.003051. Epub 2013 Sep 17.
Socioeconomic status and acculturation may modify the association between ethnicity and hypertension treatment before stroke. We assessed prestroke treatment of hypertension by ethnicity, education (proxy for socioeconomic status), and English proficiency (EP; proxy for acculturation) in a population-based stroke surveillance project.
Among 763 patients with first-ever stroke aged ≥45 years in the Brain Attack Surveillance in Corpus Christi project from 2000 to 2006, we examined self-reported hypertension treatment at the time of the stroke by ethnicity (Mexican American [MA] versus non-Hispanic white [NHW]) in the overall sample, within education strata (<high school, high school, >high school), and after dichotomizing MAs by self-reported EP (limited versus proficient). Logistic regression adjusted associations for age, sex, education, diabetes mellitus, coronary artery disease, hypercholesterolemia, and health insurance.
NHWs and MAs reported similar hypertension treatment (84% versus 86%; P=0.53). Hypertension treatment was 84% for NHWs and 90% for MAs (P=0.18) in <high school stratum, 87% for NHWs and 75% for MAs (P=0.07) in high school stratum, and 81% for NHWs and 78% for MAs (P=0.73) in >high school stratum (ethnicity-by-education interaction, P=0.09). Hypertension treatment was 83% for NHWs, 87% for MAs with EP (PvsNHWs=0.35), and 90% for MAs with limited EP (PvsNHWs=0.13; ethnicity-by-EP interaction, P=0.22). Hypertension treatment was lower in uninsured patients (adjusted odds ratio, 0.13; 95% confidence interval, 0.03-0.60) or those with no physician visit ≤6 months (adjusted odds ratio, 0.09; 95% confidence interval, 0.03-0.24).
We found no evidence that socioeconomic status or acculturation modifies the association between ethnicity and hypertension treatment before stroke.
社会经济地位和文化适应可能会改变种族与中风前高血压治疗之间的关联。我们在一个基于人群的中风监测项目中，通过种族（墨西哥裔美国人[MA]与非西班牙裔白人[NHW]）、教育程度（社会经济地位的替代指标）和英语熟练程度（文化适应的替代指标）来评估中风前高血压的治疗情况。
在 2000 年至 2006 年的脑卒中专案监测项目中，我们对 763 名年龄≥45 岁的首次脑卒中患者进行了研究，在总体样本中、在教育程度分层（<高中、高中、>高中）内，以及在根据自我报告的英语熟练程度（有限和熟练）将 MA 分为两组后，检查了自我报告的中风时的高血压治疗情况。使用逻辑回归对年龄、性别、教育程度、糖尿病、冠心病、高胆固醇血症和医疗保险进行了调整。
NHW 和 MA 报告的高血压治疗情况相似（84%对 86%；P=0.53）。在<高中教育程度分层中，NHW 和 MA 的高血压治疗率分别为 84%和 90%（P=0.18），在高中教育程度分层中分别为 87%和 75%（P=0.07），在>高中教育程度分层中分别为 81%和 78%（P=0.73）（种族-教育程度交互作用，P=0.09）。NHW 的高血压治疗率为 83%，EP 熟练的 MA 为 87%（PvsNHW=0.35），EP 有限的 MA 为 90%（PvsNHW=0.13；种族-EP 交互作用，P=0.22）。未参保患者（调整后的优势比，0.13；95%置信区间，0.03-0.60）或在≤6 个月内无医生就诊的患者（调整后的优势比，0.09；95%置信区间，0.03-0.24）的高血压治疗率较低。
我们没有发现社会经济地位或文化适应会改变种族与中风前高血压治疗之间的关联。
