Childhood adversities and prior involvement with child protective services

Objectives We aimed to determine the relation between childhood adversities and prior involvement with Child Protective Services (CPS) history among children presenting for evaluation at a Child Advocacy Center. Study design The study evaluated children presenting to a Child Advocacy Center (CAC) from 2009 to 2014. A five-item child adversity measure, based on mother’s report, was characterized into a scale of none, one, or two or more adversities. Caseworkers at the CAC assessed whether families had a prior history of involvement with CPS. Results Among the 727 children included in the analyses, 43% had a prior history of involvement with CPS. Twenty-six percent of the children experienced one childhood adversity while 29% experienced two or more. In regression analyses adjusting for socio-demographics, experiencing one (Prevalence Ratio (PR) 1.25 95%CI 1.0–1.5) or two or more adversities (PR1.67 95%CI 1.4, 2.0) was associated with higher prevalence of CPS history compared to those who reported none. Conclusions Childhood adversities are associated with prior contact with CPS, suggesting there are missed opportunities to provide services to high-risk families. CACs may be in a unique position to advocate for families and prevent further victimization of children

Differences in healthcare visit frequency and type one year prior to stroke among young versus middle-aged adults

Background The incidence and prevalence of stroke among the young are increasing in the US. Data on healthcare utilization prior to stroke is limited. We hypothesized those < 45 years were less likely than those 45–65 years old to utilize healthcare in the 1 year prior to stroke. Methods Patients 18–65 years old who had a stroke between 2008 and 2013 in MarketScan Commercial Claims and Encounters Databases were included. We used descriptive statistics and logistic regression to examine healthcare utilization and risk factors between age groups 18–44 and 45–65 years. Healthcare utilization was categorized by visit type (no visits, inpatient visits only, emergency department visits only, outpatient patient visits only, or a combination of inpatient, outpatient or emergency department visits) during the year prior to stroke hospitalization. Results Of those 18–44 years old, 14.1% had no visits in the year prior to stroke compared to 11.2% of individuals aged 45–65 [OR = 1.30 (95% CI 1.25,1.35)]. Patients 18–44 years old had higher odds of having preventive care procedures associated with an outpatient visit and lower odds of having cardiovascular procedures compared to patients aged 45–65 years. Of stroke patients aged 18–45 and 45–65 years, 16.8 and 13.2% respectively had no known risk for stroke. Conclusions Patients aged 45–65 were less commonly seeking preventive care and appeared to be seeking care to manage existing conditions more than patients aged 18–44 years. However, as greater than 10% of both age groups had no prior risk, further exploration of potential risk factors is needed

Risk of stroke and myocardial infarction after influenza-like illness in New York State

Background Influenza may be associated with increased stroke and myocardial infarction (MI) risk. We hypothesized that risk of stroke and MI after influenza-like illness (ILI) would be higher in patients in New York State. We additionally assessed whether this relationship differed across a series of sociodemographic factors. Methods A case-crossover analysis of the 2012–2014 New York Statewide Planning and Research Cooperative System (SPARCS) was used to estimate odds of ischemic stroke and MI after ILI. Each patient’s case window (the time period preceding event) was compared to their control windows (same dates from the previous 2 years) in conditional logistic regression models used to estimate odds ratios and 95% confidence intervals (OR, 95% CI). We varied the case windows from 15 to 365 days preceding event as compared to control windows constructed using the same dates from the previous 2 years. Analyses were stratified by sex, race, and urban-rural status based on residential zip code. Results A total of 33,742 patients were identified as having ischemic stroke and 53,094 had MI. ILI events in the 15 days prior were associated with a 39% increase in odds of ischemic stroke (95% CI 1.09–1.77), increasing to an almost 70% increase in odds when looking at ILI events over the last year (95% CI 1.56, 1.83). In contrast, the effect of ILI hospitalization on MI was strongest in the 15 days prior (OR = 1.24, 95% CI 1.06–1.44). The risk of ischemic stroke after ILI was higher among individuals living in rural areas in the 90 days prior to stroke and among men in the year prior to event. In contrast, the association between ILI and MI varied only across race with whites having significantly higher ILI associated MI. Conclusion This study highlights risk period differences for acute cardiovascular events after ILI, indicating possible differences in mechanism behind the risk of stroke after ILI compared to the risk of MI. High risk populations for stroke after ILI include men and people living in rural areas, while whites are at high risk for MI after ILI. Future studies are needed to identify ways to mitigate these risks

Abstract WP184: Differential Risk of Embolic Stroke Among Stroke Free Community Dwellers With Distinct Categories of Subcortical Infarct

Introduction: Cortically-based subclinical infarcts are considered risks for embolic stroke, but few studies have stratified subcortical SBI by penetrating versus medullary artery location. We hypothesized that subclinical medullary infarcts are due to small emboli and are predictors of embolic stroke. Methods: Stroke-free participants in the Northern Manhattan Study underwent a brain MRI to assess for subclinical biomarkers of vascular disease. Subcortical brain infarcts were defined voids >3mm on axial T1 and FLAIR images, with perilesional FLAIR hyperintensities referred to as pathology-informed subclinical brain infarcts (PI-SBI). Each subcortical PI-SBI was rated as penetrating or medullary by two vascular neurologists blinded to stroke subtypes. Participants were followed prospectively for incident stroke. Two vascular neurologists ascertained ischemic stroke subtypes independent of brain MRI imaging at baseline. Embolic stroke required a cardiac source or based on a superficial location. Cox proportional risk models generated hazard ratios and 95% confidence intervals (HR, 95% CI) adjusting for age, sex, ethnicity and traditional vascular risk. Results: The sample included 1290 NOMAS participants (mean age 71±9 years, 60% women, 66% Hispanic, 75% with hypertension) who were followed on average 9±3 years. At baseline, 19% of participants had PI-SBI (11% medullary artery, 7% penetrating artery and 3% cortical). During follow up, 80 participants (6.2%) had stroke (3.6% embolic, 2.4% due to intracranial artery disease (i.e. small and large), and 0.2% other subtypes). In a fully adjusted model, medullary artery (2.04, 1.00-4.14) and not penetrating artery PI-SBI (1.64, 0.99-2.70) predicted risk of embolic stroke. Distal field PI-SBI (i.e. cortical + medullary artery) were even more robust predictors of embolic stroke (2.17, 1.11-4.25). Penetrating artery (1.98, 1.09-3.61) and not medullary artery PI-SBI (HR 1.03, 0.34-3.06) predicted risk of intracranial artery stroke. Conclusions: Subtyping PI-SBI by location and plausible mechanisms may help with risk stratification for clinical trials testing stroke prevention strategies. Our data suggest not all subcortical infarcts are due to small vessel disease

Residential Proximity to Major Roadways and Risk of Incident Ischemic Stroke in NOMAS (The Northern Manhattan Study)

The evidence supporting the deleterious cardiovascular health effects of living near a major roadway is growing, although this association is not universal. In primary analyses, we hypothesized that residential proximity to a major roadway would be associated with incident ischemic stroke and that cardiovascular risk factors would modify that association. NOMAS (The Northern Manhattan Study) is an ongoing, population-based cohort study designed to measure cardiovascular risk factors, stroke incidence, and other outcomes in a multiethnic urban population. Recruitment occurred from 1993 to 2001 and participants are followed-up annually by telephone. Residential addresses at baseline were geocoded and Euclidean distance to nearest major roadway was estimated and categorized as in prior studies. We used Cox proportional hazard models to calculate hazard ratios and 95% confidence intervals for the association of this distance to incidence of stroke and other outcomes, adjusting for sociodemographic and cardiovascular risk factors, year at baseline, and neighborhood socioeconomic status. We assessed whether these associations varied by age, sex, smoking status, diabetes mellitus, and hypertension. During a median follow-up period of 15 years (n=3287), 11% of participants were diagnosed with ischemic stroke. Participants living 400 m away. This association was more pronounced among noncurrent smokers (hazard ratio, 1.54; 95% confidence interval, 1.05-2.26) and not evident among smokers (hazard ratio, 0.69; 95% confidence interval, 0.23-2.06). There was no clear pattern of association between proximity to major roadways and other cardiovascular events including myocardial infarction, all-cause death, or vascular death. In this urban multiethnic cohort, we found evidence supporting that within-city variation in residential proximity to major roadway is associated with higher risk of ischemic stroke. An individual's smoking history modified this association, with the association remaining only among participants not currently smokers

Physical Inactivity Predicts Slow Gait Speed in an Elderly Multi-Ethnic Cohort Study: The Northern Manhattan Study

Gait speed is associated with multiple adverse outcomes of aging. We hypothesized that physical inactivity would be prospectively inversely associated with gait speed independently of white matter hyperintensity volume and silent brain infarcts on MRI. Participants in the Northern Manhattan Study MRI sub-study had physical activity assessed when they were enrolled into the study. A mean of 5 years after the MRI, participants had gait speed measured via a timed 5-meter walk test. Physical inactivity was defined as reporting no leisure-time physical activity. Multi-variable logistic and quantile regression was performed to examine the associations between physical inactivity and future gait speed adjusted for confounders. Among 711 participants with MRI and gait speed measures (62% women, 71% Hispanic, mean age 74.1 ± 8.4), the mean gait speed was 1.02 ± 0.26 m/s. Physical inactivity was associated with a greater odds of gait speed in the lowest quartile (<0.85 m/s, adjusted OR 1.90, 95% CI 1.17-3.08), and in quantile regression with 0.06 m/s slower gait speed at the lowest 20 percentile (p = 0.005). Physical inactivity is associated with slower gait speed independently of osteoarthritis, grip strength, and subclinical ischemic brain injury. Modifying sedentary behavior poses a target for interventions aimed at reducing decline in mobility

Long-Term Exposure to Ambient Air Pollution and Subclinical Cerebrovascular Disease in NOMAS (the Northern Manhattan Study)

Long-term exposure to ambient air pollution is associated with higher risk of cardiovascular disease and stroke. We hypothesized that long-term exposure to air pollution would be associated with magnetic resonance imaging markers of subclinical cerebrovascular disease. Participants were 1075 stroke-free individuals aged ≥50 years drawn from the magnetic resonance imaging subcohort of the Northern Manhattan Study who had lived at the same residence for at least 2 years before magnetic resonance imaging. Cross-sectional associations between ambient air pollution and subclinical cerebrovascular disease were analyzed. We found an association between distance to roadway, a proxy for residential exposure to traffic pollution, and white matter hyperintensity volume; however, after adjusting for risk factors, this relationship was no longer present. All other associations between pollutant measures and white matter hyperintensity volume were null. There was no clear association between exposure to air pollutants and subclinical brain infarcts or total cerebral brain volume. We found no evidence that long-term exposure to ambient air pollution is independently associated with subclinical cerebrovascular disease in an urban population-based cohort

Long-term exposure to air pollution and trajectories of cognitive decline among older adults

To evaluate the association between long-term exposure to ambient air pollution and cognitive decline in older adults residing in an urban area. Data for this study were obtained from 2 prospective cohorts of residents in the northern Manhattan area of New York City: the Washington Heights-Inwood Community Aging Project (WHICAP) and the Northern Manhattan Study (NOMAS). Participants of both cohorts received in-depth neuropsychological testing at enrollment and during follow-up. In each cohort, we used inverse probability weighted linear mixed models to evaluate the cross-sectional and longitudinal associations between markers of average residential ambient air pollution (nitrogen dioxide [NO ], fine particulate matter [PM ], and respirable particulate matter [PM ]) levels in the year prior to enrollment and measures of global and domain-specific cognition, adjusting for sociodemographic factors, temporal trends, and censoring. Among 5,330 participants in WHICAP, an increase in NO was associated with a 0.22 SD lower global cognitive score at enrollment (95% confidence interval [CI], -0.30, -0.14) and 0.06 SD (95% CI, -0.08, -0.04) more rapid decline in cognitive scores between visits. Results were similar for PM and PM and across functional cognitive domains. We found no evidence of an association between pollution and cognitive function in NOMAS. WHICAP participants living in areas with higher levels of ambient air pollutants have lower cognitive scores at enrollment and more rapid rates of cognitive decline over time. In NOMAS, a smaller cohort with fewer repeat measurements, we found no statistically significant associations. These results add to the evidence regarding the adverse effect of air pollution on cognitive aging and brain health