Racial and Ethnic Differences in Short- and Long-term Mortality by Stroke Type

 You do realize that race doesn't exist except as a cultural concept? So go back to the drawing board and analyze this in a different light.

 Please go back to school and figure out the real reason for the differences.

Genetically Speaking, Race Doesn't Exist In Humans October 1998 

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Racial and Ethnic Differences in Short- and Long-term Mortality by Stroke Type

Laura Tarko, Lauren Costa, Ashley Galloway, Yuk-Lam Ho, David Gagnon, Vasileios Lioutas, Sudha Seshadri, Kelly Cho, View ORCID ProfilePeter Wilson, View ORCID ProfileHugo J. Aparicio

First published June 1, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200575 

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Abstract

Background and Objectives Racial and ethnic disparities in stroke outcomes exist, but differences by stroke type are less understood. We studied the association of race and ethnicity with stroke mortality, by stroke type, in a national sample of hospitalized patients in the Veterans Health Administration.

Methods A retrospective observational study was performed including non-Hispanic White, non-Hispanic Black, and Hispanic patients with a first hospitalization for stroke between 2002 and 2012. Stroke was determined using ICD-9 codes and date of death was obtained from the National Death Index. For each of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), we constructed a piecewise multivariable model for all-cause mortality, using follow-up intervals of ≤30 days, 31–90 days, 91 days to 1 year, and >1 year.

Results Among 37,790 patients with stroke (89% AIS, 9% ICH, 2% SAH), 25,492 (67%) were non-Hispanic White, 9,752 (26%) were non-Hispanic Black, and 2,546 (7%) were Hispanic. The cohort was predominantly male (98%). Compared with White patients, Black patients experienced better 30-day survival after AIS (hazard ratio [HR] 0.80, 95% CI 0.73–0.88; 1.4% risk difference) and worse 30-day survival after ICH (HR 1.24, 95% CI 1.06–1.44; 3.2% risk difference). Hispanic patients experienced reduced risk for >1-year mortality after AIS (HR 0.87, 95% CI 0.80–0.94), but had greater risk of 30-day mortality after SAH compared with White patients (HR 1.61, 95% CI 1.03–2.52; 10.3% risk difference).

Discussion Among US Veterans, absolute risk of 30-day mortality after ICH was 3.2% higher for Black patients and after SAH was 10.3% higher for Hispanic patients compared with White patients. These findings underscore the importance of investigating stroke outcomes by stroke type to better understand the factors driving observed racial and ethnic disparities.

Glossary

AIS=

acute ischemic stroke;

CDW=

Corporate Data Warehouse;

CMS=

Centers for Medicare & Medicaid Services;

EHR=

electronic health record;

HR=

hazard ratio;

ICD-9=

International Classification of Diseases, Ninth Revision;

ICH=

intracerebral hemorrhage;

MI=

myocardial infarction;

NIHSS=

National Institutes of Health Stroke Scale;

OR=

odds ratio;

SAH=

subarachnoid hemorrhage;

VA=

Veterans Health Administration