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Tarko L, Costa L, Galloway A, Ho YL, Gagnon D, Lioutas V, Seshadri S, Cho K, Wilson P, Aparicio HJ. Racial and Ethnic Differences in Short- and Long-term Mortality by Stroke Type. Neurology 2022; 98:e2465-e2473. [PMID: 35649728 DOI: 10.1212/wnl.0000000000200575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/01/2022] [Indexed: 01/29/2023] Open
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.
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Affiliation(s)
- Laura Tarko
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - Lauren Costa
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - Ashley Galloway
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - Yuk-Lam Ho
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - David Gagnon
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - Vasileios Lioutas
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - Sudha Seshadri
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - Kelly Cho
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - Peter Wilson
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA
| | - Hugo J Aparicio
- From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA.
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