Racial differences in the incidence of intracerebral hemorrhage - Effects of blood pressure and education

Objective: To determine the relative risk (RR) of intracerebral hemorrhage (ICH) among African Americans compared with that among whites. Methods: Dat a from the First National Health and Nutrition Examination Survey Epidemiol ogic Follow-up Study were used to determine the incidence of ICH (n = 78) i n 10,851 whites and 1,802 African Americans during a 20-year follow-up peri od. Cox proportional hazards analyses were used to determine the RR of ICH among African Americans compared with that among whites. Results: The estim ated annual incidence of ICH was 50 per 100,000 among African Americans and 28 per 100,000 among whites. The age- and sex-adjusted RR for ICH among Af rican Americans was 1.9 (95% confidence interval [CI], 1.1 to 3.2). With th e addition of systolic blood pressure and educational attainment to the Cox proportional hazards model, the RR decreased to 1.6 (95% CI, 0.9 to 2.7). The adjustment for additional cerebrovascular disease risk factors did not change this risk estimate appreciably. Conclusions: Compared with whites, A frican Americans have a twofold increased risk for ICH. Most of this risk m ay be explained by differences in educational attainment and systolic blood pressure. Unless additional efforts are undertaken to reduce racial differ ences in the prevalence of stroke risk factors, mainly systolic blood press ure and socioeconomic status, the African American-white disparities in the risk for ICH will likely continue.