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Black Americans have worse stroke outcome compared with non-Hispanic whites.
Morgenstern, Lewis B; Springer, Mellanie V; Porter, Neil C; Kwicklis, Madeline; Carrera, Joseph F; Sozener, Cemal B; Campbell, Morgan S; Hijazi, Imadeddin; Lisabeth, Lynda D.
Afiliación
  • Morgenstern LB; Department of Neurology, University of Michigan Medical School, Ann Arbor; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor. Electronic address: lmorgens@umich.edu.
  • Springer MV; Department of Neurology, University of Michigan Medical School, Ann Arbor.
  • Porter NC; Department of Neurology, University of Maryland, Baltimore.
  • Kwicklis M; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
  • Carrera JF; Department of Neurology, University of Michigan Medical School, Ann Arbor.
  • Sozener CB; Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor.
  • Campbell MS; CHRISTUS Spohn Hospitals, CHRISTUS Health system, Corpus Christi, Texas.
  • Hijazi I; Department of Neurology, University of Michigan Medical School, Ann Arbor.
  • Lisabeth LD; Department of Neurology, University of Michigan Medical School, Ann Arbor; Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor.
J Natl Med Assoc ; 115(5): 509-515, 2023 Oct.
Article en En | MEDLINE | ID: mdl-37634970
INTRODUCTION: We studied racial differences in post-stroke outcomes using a prospective, population-based cohort of stroke survivors as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project. METHODS: Neurologic (NIHSS, range of 0-42, higher scores are worse), functional (ADLs/IADLs, range 1-4, higher scores are worse), and cognitive (3MSE, range 0-100, higher scores are better) outcomes were measured 90 days after stroke. Cox proportional hazards and negative binomial linear regression models were used to examine the associations between race and 90-day all-cause mortality and NIHSS, respectively, whereas linear regression was used for ADLs/IADLs and 3MSE scores. Covariates included demographics, initial NIHSS, comorbidities, prior stroke history, tPA treatment status, pre-stroke disability, and pre-stroke cognition. The mortality model was also adjusted for DNR status. RESULTS: At 90 days post-stroke, Black American individuals (BAs) (n = 122) had a median (IQR) NIHSS of 2 (1,6) compared to NIHSS of 1 (0,3) in non-Hispanic White American individuals (NHWs) (n = 795). BAs had a median (IQR) ADL/IADL score of 2.41 (1.50, 3.39) compared to 2.00 (1.27, 2.95) in NHWs. BAs scored a median of 84 (75, 92) on the 3MSE compared to NHWs' score of 91.5 (83, 96). Death occurred in 23 (8%) of BAs and 268 (15%) of NHWs within 90 days among those who participated in baseline. After adjustment for covariates, functional outcomes at 90 days were worse in BAs compared to NHWs, with 15.8% (95% CI=5.2, 26.4) greater limitations in ADLs/IADLs and 43.9% (95% CI=12.0, 84.9) greater severity of stroke symptoms. Cognition at 90 days was 6.5% (95% CI=2.4, 10.6) lower in BAs compared to NHWs. BAs had a 35.4% lower (95% CI=-9.8, 61.9) hazard rate of mortality than NHWs. CONCLUSIONS: In this prospective, population-based community sample, BAs had worse neurologic, functional and cognitive outcomes at 90 days compared to NHWs. Future research should investigate how social determinants of health including structural racism, neighborhood factors and access to preventive and recovery services influences these racial disparities.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Accidente Cerebrovascular / Blanco Tipo de estudio: Prognostic_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Natl Med Assoc Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Accidente Cerebrovascular / Blanco Tipo de estudio: Prognostic_studies Aspecto: Determinantes_sociais_saude / Equity_inequality Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Natl Med Assoc Año: 2023 Tipo del documento: Article Pais de publicación: Estados Unidos