The Intersection of Sex, Marital Status, and Cardiovascular Risk Factors in Shaping Stroke Incidence: Results from the Health and Retirement Study

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 a...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) 2009-12, Vol.57 (12), p.2293-2299
Main Authors: Maselko, Joanna, Bates, Lisa M., Avendaño, Mauricio, Glymour, M. Maria
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Cardiovascular Diseases - complications
Cardiovascular system
Female
Gender
General aspects
Health Surveys
Humans
Incidence
Longitudinal Studies
Male
Marital Status
Medical sciences
Middle Aged
Neurology
Older people
Prevention and actions
Public health. Hygiene
Public health. Hygiene-occupational medicine
Risk Factors
sex
Sexuality
social class
Stroke
Stroke - epidemiology
Stroke - etiology
Vascular diseases and vascular malformations of the nervous system
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Summary: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.
ISSN:0002-8614
1532-5415
DOI:10.1111/j.1532-5415.2009.02555.x