ROLE OF SOCIAL-CLASS IN EXCESS BLACK STROKE MORTALITY

Background and Purpose It has been suggested that a substantial propor tion of the excess stroke mortality among black Americans may be attri butable to relatively lower socioeconomic status (SES) in this group. In this report we provide the first quantitative estimates of the prop ortion of excess black stroke mortality attributable to SES for a larg e population-based cohort. Methods We used data from the National Long itudinal Mortality Study for persons 45 years and older (73 400 white men, 87 528 while women, 6522 black men, and 8816 black women). Sex-sp ecific proportional hazards model were used to estimate excess black s troke mortality with and without adjustment for education and income ( measures of SES). The contribution of SES to the excess black stroke r isk was estimated from the difference in regression coefficients for r ace in these models. Results In men, low SES was associated with incre ased stroke mortality (P less than or equal to.0001) and accounted for 14% to 46% of the excess black stroke risk (P less than or equal to.0 5). However, we could find no association between SES and stroke morta lity in women, and SES did not account for a significant proportion of the excess stroke mortality in black women. Conclusions Although SES proved to account for a statistically significant proportion of excess male black stroke mortality, overall SES explained less than one quar ter of the observed excess between ages 45 and 65. In women, SES did n ot significantly reduce the estimated excess black stroke mortality. A lthough SES may be playing a role in excess black stroke mortality, a substantial proportion of the excess appears attributable to other sou rces, including cerebrovascular risk factors that are unrelated to SES , unmeasured lifestyle influences, social resources, and genetic facto rs.