Black, Hispanic people more likely to die than white people after some types of stroke
MINNEAPOLIS – Black and Hispanic people are more likely to die in the first month after certain types of stroke than white people, according to a study published in the June 1, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“We’ve known that there are disparities in death from stroke among racial and ethnic groups in the U.S. due to higher stroke rates, higher burden of risk factors for stroke, socioeconomic inequality and structural racism, but we have needed more information breaking these differences down by type of stroke,” said study author Hugo J. Aparicio, MD, MPH, of Boston University School of Medicine in Massachusetts and a member of the American Academy of Neurology. “These results will help us to better understand the nature of this health inequity.”
For the study, researchers reviewed health records of 37,790 people who had strokes and were hospitalized in the Veterans Health Administration over a 10-year period. They then looked at which participants died during the following month and for more than a year after the stroke.
A total of 89% of the strokes were ischemic, which are strokes caused by a blood clot. Another 9% were intracerebral hemorrhage strokes and 2% were subarachnoid hemorrhage strokes, both of which are caused by bleeding in the brain. Men made up 98% of the participants.
When researchers adjusted for factors that could affect risk of death after stroke, such as smoking, diabetes, and heart disease, Hispanic people who had subarachnoid hemorrhage strokes had a 10.3% higher risk of death during the month after the stroke than white people with the same type of stroke, with Hispanic people having a 30% increased risk and white people having a 20% increased risk. Black people who had intracerebral hemorrhage strokes had a 3% higher risk of death during the month after the stroke than white people with that type of stroke, with Black people having a 30% increased risk and white people having a 27% increased risk.
“Differences in mortality by race or ethnicity varied substantially when considering specific types of stroke, especially the different types of hemorrhagic stroke,” said Aparicio. “If all types of stroke are considered together as one disease, it may mask underlying racial or ethnic disparities, since risk factors, such as age or blood pressure, and underlying social determinants of health, such as access to health care or structural racism, may vary differently between these outcomes. Given these differences in stroke mortality by race and ethnicity, it is clear that more research is also needed in Native American, Alaska Native, Native Hawaiian and Asian American groups.”
Aparicio noted that future studies should look into group differences in vascular risk factors and management of risk factors, stroke severity, and the effects of racism that may contribute to this inequity in surviving after a stroke.
A limitation of the study was that nearly all of the participants were male veterans, so the results may not apply to women and the general population. In addition, the researchers were not able to adjust for the severity of the strokes.
The study was supported by the Department of Veterans Affairs.
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JOURNAL
Neurology
Racial and ethnic disparities in stroke outcomes
Black and Hispanic patients experienced poorer survival after certain strokes
Peer-Reviewed Publication(Boston)—Stroke is the fifth leading cause of death in the U.S. Despite declines in stroke mortality in the overall population in recent decades, disparities in incidence remain persistent among Black and Hispanic Americans. Now a new study has found that inequality in survival among Black and Hispanic Americans varies by stroke type.
“While racial and ethnic disparities in stroke outcomes exist, differences by stroke type are less understood. Current evidence for racial and ethnic disparities in stroke mortality, particularly by stroke type, is needed to better understand and characterize the scope of this health inequity,” explained corresponding author Hugo J. Aparicio, MD, MPH, assistant professor of neurology at Boston University School of Medicine and an investigator at the Framingham Heart Study.
Health disparities in stroke patients were investigated among patients admitted to VA hospitals in the U.S. between the years 2002-12. Strokes were categorized into three types: acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Race and ethnicity data were collected, and patients were categorized as either non-Hispanic White, non-Hispanic Black (African American), or White or Black Hispanic (Latino). The researchers then compared the incidence of death at various time periods after the stroke (hospital admission date to 30 days, 31-90 days, 91 days to one year, and greater than one year).
While Black patients were less likely to die within the first 30 days of hospital admission for AIS, compared to White patients, Black patients experienced higher mortality (3.2 percent higher) compared to White patients within the first 30 days following ICH, while Hispanics had similar mortality compared to Whites for ICH. For SAH, Hispanics had a higher 30-day mortality (10.3 percent higher) compared to Whites, but no other differences in mortality were seen between the two groups for other time periods.
According to the researchers, some causes of disparities seen in survival could be attributed to decreased access to health care services (e.g., for blood pressure medication prescription), less community outreach for preventive health interventions, or variations in acute care or post-hospital discharge processes of care for minority populations. “Furthermore, the prevalence of uncontrolled high blood pressure in the Black population could contribute to higher rates of stroke. Therefore further investigation categorized by stroke type is warranted to address determinants of health inequity, such as individual health risk factors, care process within the hospital, or factors outside the healthcare system, that could be contributing to stroke mortality,” adds Dr. Aparicio.
The researchers believe future studies should investigate group differences in vascular risk factors and risk factor management, stroke severity, the effects of structural racism, and social determinants of health that may contribute to this inequity in stroke survival.
These findings appear in the journal Neurology®, the medical journal of the American Academy of Neurology.
Funding for this study was provided by Veterans Affairs Merit Award I01 CX001025 (Wilson & Cho). Dr. Aparicio is supported by the National Institute on Aging (R01AG054076-02S1), the National Institute of Neurological Disorders and Stroke (L30 NS093634), an American Academy of Neurology Career Development Award, and the Boston University Aram V. Chobanian Assistant Professorship.
JOURNAL
Neurology
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Racial and Ethnic Differences in Short- and Long-term Mortality by Stroke Type
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