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November 29, 2016; 87 (22) Article

Neighborhood socioeconomic index and stroke incidence in a national cohort of blacks and whites

Virginia J. Howard, Leslie A. McClure, Dawn O. Kleindorfer, Solveig A. Cunningham, Amanda G. Thrift, Ana V. Diez Roux, George Howard
First published October 14, 2016, DOI: https://doi.org/10.1212/WNL.0000000000003299
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Article Information

vol. 87 no. 22 2340-2347
DOI: 
https://doi.org/10.1212/WNL.0000000000003299
PubMed: 
27742815
Published By: 
Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology
Print ISSN: 
0028-3878
Online ISSN: 
1526-632X
History: 
  • Received April 16, 2016
  • Accepted in final form August 19, 2016
  • First Published October 14, 2016.

Article Versions

Copyright & Usage: 
© 2016 American Academy of Neurology

Author Disclosures

    1. Virginia J. Howard, PhD,
    2. Leslie A. McClure, PhD,
    3. Dawn O. Kleindorfer, MD,
    4. Solveig A. Cunningham, PhD,
    5. Amanda G. Thrift, PhD,
    6. Ana V. Diez Roux, PhD and
    7. George Howard, DrPH
  1. Virginia J. Howard, PhD,
    2. Scientific Advisory Boards:

    1. Self - (1) Serve on DSMB for NIH-NIDA; (2) Scientific Advisory Board, NIH-NINDS Stroke Prevention Intervention and Research Program NYU/Columbia University Center for Stroke Disparities and Solutions. Immediate family member scientific advisory boards for: (1) NIH-NHLBI cohort study and (2) Bayer-funded ARRIVE (Aspirin to reduce the risk of initial vascular events) (Bayer); Spouse served on DSMB for NIDCD for Acute Video- oculography for Vertigo in Emergency Rooms for Rapid Triage (AVERT) Study

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. Travel and speaker honoraria for NYU/Columbia University

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. Personal - NIH review committees, Ochsner Foundation Immediate family member consulting: NIH review committees

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. Self: 1) NIH-NINDS, NS41588, (REGARDS) co-PI, 2001- present, (2) NIH-NINDS, NS38384 (CREST), co-investigator, 1999-present, (3) NIH-NIA AG039588 (Childhood SES), PI, 2011-present (4) NIH-NIA 5P30AG031054 (RCMAR), co- investigator, 2012-present (5) NIH/NIMHD P30MD000502 (Disparities Center), 2012-present, (6) NIH/NINDS R01NS080850 (Mineral metabolism), 2012-present(7) NIH/NINDS 1U01NS080165 (CREST-2), co-investigator, 2014- present Spouse: 1) NIH-NINDS, NS41588, co-PI, 2001- present, (2) NIH-NINDS, NS38384, co-investigator, 1999-present, (3) NIH/NINDS 1U01NS080165 (CREST-2), PI, 2014-present

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  2. Leslie A. McClure, PhD,
    3. Scientific Advisory Boards:

    1. DSMB for: NIH PCORI

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1) NIH/NINDS NS041588 Co-I 2012-2017 (2) NIH/NIEHS ES021735 Co-PI 2012-2017 (3) NIH/NIA AG039588 Co-I 2011-2017 (4) NIH/NICHD HD078371 Co-I 2015-2017

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  3. Dawn O. Kleindorfer, MD,
    4. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. 1) Genentech, speaker's bureau travel, 2008-present

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. Genentech, modest level

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. R01 NS30678 Kissela and Kleindorfer (PI) 4/1/2015 ? 3/30/2020 3.60 cal mos NIH $7,578,621 Hemorrhagic and Ischemic Stroke Among Blacks and Whites (EPI) Role: Co-PI U01 NS041588 Howard (PI) ? Kissela (Site PI) 09/24/2011 ? 11/30/2017 3.00 cal mos Subaward w/Univ of Alabama Birmingham $116,286 ?Etiology of Geographic and Racial Differences in Stroke (REGARDS)? U01NS086872 (Broderick) 09/30/2013 ? 07/31/2018 2.40 cal mos NIH/NINDS $1,623,735 ?NSTN National Clinical Coordinating Center? U10 NS086512 (Khatri/Kleindorfer) 09/30/2013 ? 07/31/2018 1.80 cal mos NIH/NINDS $250,000 ?Cincinnati Regional Coordinating Stroke Center (Cincinnati RCC)?

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  4. Solveig A. Cunningham, PhD,
    5. Scientific Advisory Boards:

    1. NONE

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. NONE

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. Agency: National Institute of Aging Period: 01/01/2012 ? 01/01/2017 Role: Co-I (Emory Subcontract PI)

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  5. Amanda G. Thrift, PhD,
    6. Scientific Advisory Boards:

    1. (1) National Health & Medical Research Council (Australia), Research Committee (2) Stroke Foundation, Research Advisory Committee (3) Family-led rehabilitation trial after stroke in India, Data Safety Monitoring Committee

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. (1) World Stroke Organisation, travel expenses

    Editorial Boards:

    1. (1) Stroke, editorial advisory board, 2009-2016 (2) Stroke, co-editor of the Health Policy and Outcomes section, 2010-2016 (3) International Journal of Stroke, editorial advisory board, 2005-2016 (4) Neuroepidemiology, editorial advisory board, 2007-2016

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other activities:

    1. (1) Stroke Foundation (Australia), Board Member

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. (1) National Health and Medical Research Council (Australia), 586605, Chief Investigator, 2010-2014 (2) National Health and Medical Research Council (Australia), 1040030, Chief Investigator, 2012-2015 (3) National Health and Medical Research Council (Australia), 1041401, Chief Investigator, 2013-2016 (4) National Health and Medical Research Council (Australia), 1042600, Chief Investigator, 2013-2017 (5) National Health and Medical Research Council (Australia), 1034415, Chief Investigator, 2012-2015 (6) National Health and Medical Research Council (Australia), 1104528, Chief Investigator, 2016-2019 (7) National Health and Medical Research Council (Australia), 1050672, Chief Investigator, 2013-2015 (8) National Health and Medical Research Council (Australia), 1023650, Chief Investigator, 2012-2015 (9) National Health and Medical Research Council (Australia), 1024575, Chief Investigator, 2012-2015 (10) European Commission: 7th Framework, SEP-210080487, Chief Investigator, 2014-2017 (11) Australian Research Council, DP140103045, Chief Investigator, 2014-2016

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. (1) ANZ Trustees, Chief Investigator, No identifier, 2014

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  6. Ana V. Diez Roux, PhD and
    7. Scientific Advisory Boards:

    1. EPA Advisory Board Board of Scientific Counsellors NICHS

    Gifts:

    1. NONE

    Funding for travel or speaker honoraria:

    1. Society for Health Promotion speaker honorarium. Yale School of Public Health speaker honorarium Emory School of public health speaker honorarium

    Editorial Boards:

    1. American Journal of Epidemiology Journak of Epidemioloy and Community Health Journal of Urban Health Environmnetal Health Perspectives

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. NIH

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. RWJF

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  7. George Howard, DrPH
    8. Scientific Advisory Boards:

    1. 2014 ? Present NIDCD DSMB : Acute Video-oculography for Vertigo in Emergency Rooms for Rapid Triage (AVERT) Study 2006 ? Present Executive Committee, Aspirin to Reduce Risk of Initial Vascular Events (ARRIVE) Study, Bayer HealthCare. 2013 ? Present Member, Data Safety Monitoring Board. A randomized, double-blind, placebo-controlled, multi-center trial to evaluate the safety and efficacy of eculizumab in patients with relapsing neuromyeltis optica (NMO). Alexion. 2007 ? Present NHLBI. Hispanic Study, Observational Studies Monitoring Board (Chair) 2007 ? Present NHLBI. Vest prevention of early sudden death trial (VEST) and Prediction of ICD Therapies Study (PREDICTS). Data and Safety Monitoring Board. 2010 ? Present NINDS. PARTNERS Study, Data and Safety Monitoring Committee. 2011 ? Present NIDDK. The Environmental Determinants of Diabetes in the Young (TEDDY), Data and Safety Monitoring Board 2012 ? 2014 NHLBI. Phosphodiesterase Type 5 Inhibition with Tadalafil Changes Outcomes in Heart Failure (PITCH-HF) Data and Safety Monitoring Board (member). 2012 ? Present NINDS. CRISP Study, Data and Safety Monitoring Committee. 2014 ? Present NHLBI. Data and Safety Monitoring Board. Trial of Post-Operative Low Molecular Weight Heparin Bridging Therapy versus Placebo Bridging Therapy for Patients Who Are at High Risk for Arterial Thromboembolism (PERIOP 2) 2013 ? Present Alexion: Member Data and Safety Monitoring Board. A randomized, double-blind, placebo-controlled, multicenter trial to evaluate the safety and efficacy of Eculizumab in patients with relapsing neuromyelitis optica. 2015 ? Present NHLBI DSMB: Individualized Comparative Effectiveness of Models Optimizing Patient Safety and Resident Education (iCOMPARE)

    Gifts:

    1. NONE

    Funding for Travel or Speaker Honoraria:

    1. NONE

    Editorial Boards:

    1. Stroke Section Editor Stroke and Cerebrovascular Disease Editorial Board

    Patents:

    1. NONE

    Publishing Royalties:

    1. NONE

    Employment, Commercial Entity:

    1. NONE

    Consultancies:

    1. NONE

    Speakers' Bureaus:

    1. NONE

    Other Activities:

    1. NONE

    Clinical Procedures or Imaging Studies:

    1. NONE

    Research Support, Commercial Entities:

    1. NONE

    Research Support, Government Entities:

    1. U01 NS41588 (G Howard) 9/1/2001 ? 11/30/2017 2.7 calendar NIH/NINDS $ 4,501,243 (current year direct) Etiology of Geographic and Racial Differences in Stroke (REGARDS) The major goals of this project are to provide national data on stroke incidence, case fatality, prevalence of cerebrovascular risk factors and lifestyle choices ad assess geographic and racial variations in these. R01 NS38384 (Brott) (subcontract) 1/1/2008 ? 12/31/2015 1.8 calendar New Jersey/NIH/NINDS $ 304,556 (current year direct) Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) CREST is a randomized clinical trial of cerebrovascular symptomatic patients with high-grade stenosis randomized to carotid endarterectomy (CEA) and carotid angioplasty with stenting (CAS). Primary endpoints are any stroke, MI or death in the 30-day peri-procedural period, or ipsilateral stroke in the post-30 day period. The unit at UAB is the statistical coordinating center for the trial. R01 NR012726 (Wang) 7/1/2011 ? 6/30/2016 .48 calendar NINR $ 336,815 (current year direct) Risk Factors for Sepsis in the Community Sepsis, a condition of enormous public health importance, has two-fold regional variation in mortality in the US, with the highest cluster in the Southeastern US. This proposed study will advance sepsis science by identifying individual and community-level factors amenable to risk reduction, potentially leading to strategies to prevent sepsis and reduce its high mortality. Objectives include: (1) identifying individuals, family, community and societal/system healthcare factors associated with sepsis attack rate and case fatality, and (2) determining their mediating effects on regional sepsis variations Muntner 1/23/14 ? 2/27/15 .6 calendar AMGEN, Inc. $ 1,054,376 (current year direct) Cardiovascular Disease, Prevention, Treatment, and Outcomes R01 HL117323 (Muntner) 7/15/13 ? 6/30/16 .6 calendar NIH/NHLBI $ 378,927 (current year direct) Incorporation of a Hypertension Working Group into the Jackson Heart Study U01 NS080165 (G Howard) 3/15/14 ? 2/28/21 2.7 calendar NIH/NINDS $ 849,691 (current year direct) CREST-2 Statistical and Data Coordinating Center ? (SDCC) CREST-2 is a pair of randomized trials to assess potential stroke reduction: 1) carotid endarterectomy plus aggressive medical management versus medical management alone, and 2) carotid stenting plus aggressive medical management versus medical management alone. Each trial will have approximately 1,240 patients randomized and followed for up to 4 years for any stroke during a 44-day peri-procedural period plus ipsilateral stroke over a follow-up period extending 4 years. The study will be performed in approximately 120 clinical centers in the US and Canada. P20 GM109098 (Frisbee) 09/08/2014 ? 05/31/2019 .6 calendar NIH/NIGMS/West Virginia University $ 83,359 (current year direct) Effects of Perfluoralkyl Chemicals on Stroke Incidence, Mortality and Morbidity This project will systematically evaluate the effects of multiple PFC compounds on stroke risk and outcome in a diverse cohort and so results will be broadly generalizable. This proposed project is relevant to both NIEHS and NIH, as it discovers how the environment affects people soa as to lennhten life and promote healthier lives.

    Research Support, Academic Entities:

    1. NONE

    Research Support, Foundations and Societies:

    1. NONE

    Stock/Stock Options/Board of Directors Compensation:

    1. NONE

    License Fee Payments, Technology or Inventions:

    1. NONE

    Royalty Payments, Technology or Inventions:

    1. NONE

    Stock/Stock Options, Research Sponsor:

    1. NONE

    Stock/Stock Options, Medical Equipment & Materials:

    1. NONE

    Legal Proceedings:

    1. NONE

  1. From the Department of Epidemiology (V.J.H.), School of Public Health, University of Alabama at Birmingham; Department of Epidemiology and Biostatistics (L.A.M., G.H.), Dornsife School of Public Health (A.V.D.R.), Drexel University, Philadelphia, PA; Department of Neurology (D.O.K.), University of Cincinnati College of Medicine, OH; Hubert Department of Global Health and Department of Sociology (S.A.C.), Emory University, Atlanta, GA; Epidemiology & Prevention Division (A.G.T.), Stroke and Ageing Research (STARC), Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton; and The Florey Institute of Neuroscience and Mental Health (A.G.T.), Melbourne University, Heidelberg, Australia.
  1. Correspondence to Dr. Howard: vjhoward{at}uab.edu
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