Department of Neurology, Yale University School of Medicine, 15 York Street, New Haven, CT 06510, USA.
Department of Neurology, Columbia University, New York, NY, USA.
J Stroke Cerebrovasc Dis. 2022 Feb;31(2):106219. doi: 10.1016/j.jstrokecerebrovasdis.2021.106219. Epub 2021 Nov 23.
Self-reported Black (SRB) Americans are approximately twice as likely to have a stroke as self-reported White (SRW) Americans. While social determinants of health and vascular risk factors account for some of the disparity, half the increased risk remains unexplained and may be related to unmeasured real-world factors of the racialized experience.
and Methods In this cohort study, we compared SRB and SRW participants in the Systolic Blood Pressure Intervention Trial (SPRINT) to the same groups in the observational Atherosclerosis Risk in Communities (ARIC) study to evaluate if clinical trial participation mitigates disparities in stroke risk. We set the ARIC baseline at visit 4 and excluded participants with prior stroke to create an ARIC cohort similar in age to SPRINT participants. The study outcome was incident primary stroke. We report hazard ratios from Cox models and inverse-probability weighted Cox models with propensity score matching on participant age, sex, diabetes, atrial fibrillation, and smoking.
We included 10,094 patients from ARIC and 8,869 from SPRINT, of which 26.1% were SRB. The risk of stroke between SRW participants in SPRINT versus ARIC was not significantly different (IPW-Weighted HR 0.78 [0.52-1.19]). SRB ARIC participants were twice as likely to have a stroke as SRW ARIC participants (IPW-Weighted HR = 1.96 [1.41-2.71]). However, SRB SPRINT participants did not have higher stroke risk compared to SRW SPRINT or ARIC participants (IPW-Weighted HR 0.99 [0.68--1.77] and 0.95 [.57-1.59], respectively). SRB SPRINT participants in the intensive BP control group had a lower risk of stroke compared to SRB ARIC participants (IPW-Weighted HR = 0.39 [0.20-0.75]).
SRB race, compared to SRW race, is associated with an increase in primary stroke risk in the ARIC study but not in the SPRINT trial. The absence of the racial disparity in stroke incidence in SPRINT indicates that aspects of the disparity are modifiable. Population-based interventions that test this hypothesis deserve further attention.
自我报告的黑人（SRB）美国人患中风的几率是自我报告的白人（SRW）美国人的两倍。尽管健康的社会决定因素和血管风险因素解释了部分差异，但仍有一半的风险增加无法解释，这可能与种族经历中未测量的实际因素有关。
在这项队列研究中，我们将 Systolic Blood Pressure Intervention Trial（SPRINT）中的 SRB 和 SRW 参与者与 Atherosclerosis Risk in Communities（ARIC）研究中的相同组进行了比较，以评估临床试验参与是否减轻了中风风险的差异。我们将 ARIC 的基线设定在第 4 次就诊时，并排除了有既往中风的参与者，以创建一个与 SPRINT 参与者年龄相似的 ARIC 队列。研究结果是首发原发性中风。我们报告了 Cox 模型和倾向评分匹配的逆概率加权 Cox 模型的风险比。
我们纳入了来自 ARIC 的 10094 名患者和来自 SPRINT 的 8869 名患者，其中 26.1%是 SRB。SPRINT 中的 SRW 参与者与 ARIC 中的 SRW 参与者相比，中风风险没有显著差异（加权 HR 0.78 [0.52-1.19]）。然而，与 ARIC 中的 SRW 参与者相比，ARIC 中的 SRB 参与者发生中风的风险几乎是后者的两倍（加权 HR 1.96 [1.41-2.71]）。然而，与 SRW SPRINT 或 ARIC 参与者相比，SRB SPRINT 参与者的中风风险并没有更高（加权 HR 分别为 0.99 [0.68-1.77] 和 0.95 [.57-1.59]）。与 ARIC 中的 SRB 参与者相比，接受强化血压控制的 SRB SPRINT 参与者的中风风险较低（加权 HR 0.39 [0.20-0.75]）。
与 SRW 种族相比，SRB 种族与 ARIC 研究中首发中风风险的增加有关，但在 SPRINT 试验中则没有。在 SPRINT 中没有出现中风发病率的种族差异表明，这种差异的某些方面是可以改变的。值得进一步关注基于人群的干预措施，以检验这一假设。
