U.S. blacks have a life expectancy that is significantly shorter than whites, with a larger difference between men than women. Cardiovascular diseases (CVD) are the single largest contributor to this disparity. Geographic disparities in health are similar to racial disparities in magnitude and effect. There is growing recognition that there are shared risk factors for CVD and cognitive impairment. Much of the research attempting to explain these racial and geographic disparities in health has focused on the participant's socioeconomic status (SES) or place of residence at the time of diagnosis or death. Increasing evidence, however, points to an important role of exposures during earlier lifecourse periods. The role of lifecourse exposures is difficult to study, however, because migration patterns obscure the links between geographic exposures and long- term health outcomes. The general aim of this study is to identify childhood and family SES factors (CH-SES) that shape disparities in vascular and cognitive health. Designed to determine the causes of racial and geographic differences in stroke incidence, mortality and cognitive decline, the REGARDS (REasons for Geographic And Racial Differences in Stroke) study is a national population-based cohort study. REGARDS recruited 30,239 participants aged 45 or older, from 2003-2007, 45% men, 42% blacks. Data were collected using a combination of telephone interview, in-home physical exam, and self-administered questionnaire. Participants are currently being followed for CVD events and cognitive assessments. Our approach builds on the exceptional resources in REGARDS, in particular, the detailed residential history data. This study proposes to obtain data on CH-SES factors from three sources: 1) new data collected from the cohort via a mail-questionnaire; 2) linking existing REGARDS data on childhood residence to public Census data on family and community level SES conditions; and 3) linking existing REGARDS data on childhood residence to historic public school records on school quality at the county/school district level. These data on CH-SES will be linked to the detailed data on demographic and clinical characteristics of the cohort and examined as predictors of CVD and cognitive decline over follow-up.
This research focuses on the contribution of social factors to geographic and racial disparities in cardiovascular disease and cognitive impairment. Differences in social conditions across the lifecourse confound black-white and regional comparisons where childhood exposures probably influence associations between adult exposures and health outcomes. Understanding social contributors and ages where they are most influential are important to efforts to reduce health disparities across all racial and geographic groups.
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