Psychosocial Stress and Risk for Intracerebral Hemorrhage in the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) Study

BACKGROUND: Intracerebral hemorrhage (ICH) carries a 30-day mortality rate of 40% to 50% and a high burden of disability. Prior studies found that psychosocial stressors are associated with hypertension, ischemic stroke, and important racial/ethnic differences in baseline stress exist. We sought to determine whether stress, including distinct subtypes, predicts risk of ICH after controlling for important risk factors; whether its effect is mediated by hypertension; and whether important racial/ethnic differences in stress-associated ICH exist. METHODS: Data from the ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage) study, a prospective, multicenter, case– control study of ICH among White, Black, and Hispanic patients were used. Controls matched 1:1 by sex and race or ethnicity. Participants rated 4 stress subtypes (financial, health, emotional well-being, and family) on a 0 to 10 scale for the week before ICH, with 0 signifying no stress and 10 highest stress. Univariate and multivariable logistic regressions to assess each stress type as a risk factor for ICH and mediation analyses to determine whether hypertension mediated the association between stress and ICH were performed. RESULTS: There were 2964 case/control matches (41.4% female, 33.7% Black, and 32.7% Hispanic). Higher levels of each stress subtype increased probability of ICH: financial, health, emotional well-being, family, and total stress. Financial stress was associated with nonlobar ICH and disproportionately affected Black and Hispanic patients. Hypertension was found to mediate the ICH risk effects of health, emotional well-being, and family stress. CONCLUSIONS: Psychosocial stress remains a risk factor for ICH after controlling for hypertension. Novel mechanisms underlying this association warrant further study and offer a new target for ICH risk mitigation. REGISTRATION: URL: clinicaltrials.gov; Unique Identifier: NCT01202864.