Stress and Risk of Intracerebral Hemorrhage in the Ethnic/Racial Variation of Intracerebral Hemorrhage (ERICH) Study (S10.003)

Objective: We sought to determine whether psychosocial stress is an independent risk factor for intracerebral hemorrhage (ICH), and whether there is a differential association of stress with lobar vs. non-lobar ICH. Background: ICH carries a 30-day mortality rate of 40%–50% and a high burden of disability among survivors. Hypertension is a known strong independent risk factor for ICH. Prior studies have found that psychosocial stressors are associated with hypertension. However, the association between stress and ICH has not been directly investigated. Design/Methods: The ERICH Study is a prospective, multicenter, case-control study of ICH among whites, blacks, and Hispanics. Controls matched 1:1 by sex and race/ethnicity were identified by random digit dialing. Past medical history and clinical data were obtained through personal interview and chart abstraction. Participants rated levels of four stress types—financial, health, emotional wellbeing, and family—on a 0–10 scale for the week prior to ICH, with 0 being no stress and 10 the highest stress. For this analysis, univariate and multivariate logistic regressions were performed to assess each stress type as independent risk factors for ICH. Results: There were 2964 case-control matches (41.4% female; 33.7% black and 32.7% Hispanic). In multivariate analysis adjusting for age, hypertension, hypercholesterolemia, alcohol, dementia, and anticoagulant use, higher levels of each stress factor increased the probability of ICH: financial (OR=1.04, 95%CI 1.02–1.06), health (1.06, 1.04–1.09), emotional wellbeing (1.12, 1.10–1.15), and family (1.06, 1.04–1.08). Additionally, higher financial stress was associated with non-lobar ICH (p Conclusions: This analysis is the first to demonstrate psychosocial stress as an independent risk factor for ICH. Since the relationship between stress and ICH was independent of hypertension, other biologic mechanisms underlying this association must be investigated. Detailed examination of socioeconomic factors may help unravel the complex interactions between stress, hypertension, and ICH. Study Supported by: This study was funded by a grant from the National Institutes of Neurological Disorders and Stroke (Grant: RO1 NS69763). Disclosure: Dr. Behymer has nothing to disclose. Dr. Coleman has nothing to disclose. Dr. Sekar has nothing to disclose. Dr. Turner has nothing to disclose. Dr. Moomaw has nothing to disclose. Dr. Osborne has nothing to disclose. Dr. Wethington has nothing to disclose. Dr. Woo has nothing to disclose.