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Robinson DJ, Ding L, Howard G, Stanton RJ, Khoury J, Sucharew H, Haverbusch M, Nobel L, Khatri P, Adeoye O, Broderick JP, Ferioli S, Mackey J, Woo D, Rios La Rosa FDL, Flaherty M, Slavin S, Star M, Martini SR, Demel S, Walsh KB, Coleman E, Jasne AS, Mistry EA, Kleindorfer D, Kissela B. Temporal Trends and Racial Disparities in Long-Term Survival After Stroke. Neurology 2024; 103:e209653. [PMID: 39008784 PMCID: PMC11249510 DOI: 10.1212/wnl.0000000000209653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/20/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Few studies have examined trends and disparities in long-term outcome after stroke in a representative US population. We used a population-based stroke study in the Greater Cincinnati Northern Kentucky region to examine trends and racial disparities in poststroke 5-year mortality. METHODS All patients with acute ischemic strokes (AISs) and intracerebral hemorrhages (ICHs) among residents ≥20 years old were ascertained using ICD codes and physician-adjudicated using a consistent case definition during 5 periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, and 2015. Race was obtained from the medical record; only those identified as White or Black were included. Premorbid functional status was assessed using the modified Rankin Scale, with a score of 0-1 being considered "good." Mortality was assessed with the National Death Index. Trends and racial disparities for each subtype were analyzed with logistic regression. RESULTS We identified 8,428 AIS cases (19.3% Black, 56.3% female, median age 72) and 1,501 ICH cases (23.5% Black, 54.8% female, median age 72). Among patients with AIS, 5-year mortality improved after adjustment for age, race, and sex (53% in 1993/94 to 48.3% in 2015, overall effect of study year p = 0.009). The absolute decline in 5-year mortality in patients with AIS was larger than what would be expected in the general population (5.1% vs 2.8%). Black individuals were at a higher risk of death after AIS (odds ratio [OR] 1.23, 95% CI 1.08-1.39) even after adjustment for age and sex, and this effect was consistent across study years. When premorbid functional status and comorbidities were included in the model, the primary effect of Black race was attenuated but race interacted with sex and premorbid functional status. Among male patients with a good baseline functional status, Black race remained associated with 5-year mortality (OR 1.4, 95% CI 1.1-1.7, p = 0.002). There were no changes in 5-year mortality after ICH over time (64.4% in 1993/94 to 69.2% in 2015, overall effect of study year p = 0.32). DISCUSSION Long-term survival improved after AIS but not after ICH. Black individuals, particularly Black male patients with good premorbid function, have a higher mortality after AIS, and this disparity did not change over time.
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Affiliation(s)
- David J Robinson
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Lili Ding
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - George Howard
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Robert J Stanton
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Jane Khoury
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Heidi Sucharew
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Mary Haverbusch
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Lisa Nobel
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Pooja Khatri
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Opeolu Adeoye
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Joseph P Broderick
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Simona Ferioli
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Jason Mackey
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Daniel Woo
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Felipa De Los Rios La Rosa
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Matthew Flaherty
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Sabreena Slavin
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Michael Star
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Sharyl R Martini
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Stacie Demel
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Kyle B Walsh
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Elisheva Coleman
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Adam S Jasne
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Eva A Mistry
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Dawn Kleindorfer
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
| | - Brett Kissela
- From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor
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