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The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: results from the health and retirement study

Maselko, Joanna, Bates, Lisa M., Avendano, Mauricio and Glymour, M. Maria (2009) The intersection of sex, marital status, and cardiovascular risk factors in shaping stroke incidence: results from the health and retirement study. Journal of the American Geriatrics Society, 57 (12). pp. 2293-2299. ISSN 0002-8614

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Identification Number: 10.1111/j.1532-5415.2009.02555.x


OBJECTIVES: To examine the role of sex and marital status in the distribution and consequences of cardiovascular risk factors for stroke. DESIGN: Longitudinal cohort. SETTING: U.S. national sample, community based. PARTICIPANTS: U.S. adults aged 50 and older and their spouses. MEASUREMENTS: Health and Retirement Study (HRS) participants born between 1900 and 1947 (N=22,818), aged 50 and older, and stroke-free at baseline were followed an average of 9.4 years for self- or proxy-reported stroke (2,372 events). Financial resources, behavioral risk factors, and cardiovascular conditions were used to predict incident stroke in Cox proportional hazard models stratified according to sex and marital status (married, widowed, divorced or separated, or never married). RESULTS: Women were less likely to be married than men. The distribution of risk factors differed according to sex and marital status. Men had higher incident stroke rates than women, even after full risk factor adjustment (hazard ratio (HR)=1.22, 95% confidence interval (CI)=1.11–1.34). For both sexes, being never married or widowed predicted greater risk, associations that were attenuated after adjustment for financial resources. Widowed men had the highest risk (HR=1.40, 95% CI=1.12–1.74 vs married women). Lower income and wealth were associated with similarly high risk across subgroups, although this risk factor especially affected unmarried women, with this group reporting the lowest income and wealth levels. Most other risk factors had similar HRs across subgroups, although moderate alcohol use did not predict lower stroke risk in unmarried women. CONCLUSION: Stroke incidence and risk factors vary substantially according to sex and marital status. It is likely that gendered social experiences, such as marriage and socioeconomic disadvantage, mediate pathways linking sex and stroke.

Item Type: Article
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Additional Information: © 2009 The Authors
Divisions: Social Policy
LSE Health
Lifecourse, Ageing & Population Health
Subjects: R Medicine > RA Public aspects of medicine
Sets: Departments > Social Policy
Research centres and groups > LSE Health
Research centres and groups > ALPHA (Ageing, Lifecourse and Population Health Analysis)
Date Deposited: 15 Jun 2011 13:15
Last Modified: 20 Jun 2021 02:57

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