TY - JOUR
T1 - Racial disparities in post-stroke functional outcomes in young patients with ischemic stroke
AU - Jones, Erica M.
AU - Okpala, Munachi
AU - Zhang, Xu
AU - Parsha, Kaushik
AU - Keser, Zafer
AU - Kim, Christina Y.
AU - Wang, Austin
AU - Okpala, Nnedinma
AU - Jagolino, Amanda
AU - Savitz, Sean I.
AU - Sharrief, Anjail Z.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Background and purpose: Recent studies show rising incidence of stroke in the young, for which risk factors are not well characterized. There is evidence of increased risk in certain racial and ethnic groups. We assessed racial differences in risk factors, stroke etiology, and outcomes among young stroke patients. Methods: Using data from our inpatient registry for ischemic stroke, we reviewed patients aged 18–50 who were admitted 01/2013 to 04/2018. Race/ethnicity were characterized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HIS). For univariate comparisons Chi-square and Kruskal–Wallis tests were performed as appropriate. Multivariable logistic regression was used to assess impact of race on day seven modified Rankin score (mRS). Results: Among 810 patients with race and outcome data who were admitted in the study period, median age was 43, 57.1% were male, and 36.5% NHW, 43.2% NHB, 20.2% HIS. History of hypertension (HTN), type II diabetes (DM II), smoking, heart failure (CHF), prior stroke, and end-stage renal disease varied significantly by race. Compared to NHW, NHB had higher odds of HTN (OR 2.28, 1.65–3.15), CHF (OR 2.17, 1.06–4.46), and DM II 1.92 (1.25–2.94) while HIS had higher odds of DM II (OR 2.52, 1.55–4.10) and lower odds of smoking (OR 0.56, 0.35–0.90). Arrival NIHSS was higher in NHB, but etiology and rates of tpA treatment and thrombectomy did not vary by race. Compared to NHW patients, NHB (OR 0.50 CI (0.31–0.78)) and HIS (OR 0.37 CI (0.21–0.67)) were less likely to have good functional outcome (mRS <2) at day 7 in adjusted analyses. Conclusions: In this study, there was a higher prevalence of several modifiable risk factors in NHB and HIS young stroke patients and early functional outcome was worse in these groups. Our study suggests a need for targeted prevention efforts for younger populations at highest risk for stroke.
AB - Background and purpose: Recent studies show rising incidence of stroke in the young, for which risk factors are not well characterized. There is evidence of increased risk in certain racial and ethnic groups. We assessed racial differences in risk factors, stroke etiology, and outcomes among young stroke patients. Methods: Using data from our inpatient registry for ischemic stroke, we reviewed patients aged 18–50 who were admitted 01/2013 to 04/2018. Race/ethnicity were characterized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HIS). For univariate comparisons Chi-square and Kruskal–Wallis tests were performed as appropriate. Multivariable logistic regression was used to assess impact of race on day seven modified Rankin score (mRS). Results: Among 810 patients with race and outcome data who were admitted in the study period, median age was 43, 57.1% were male, and 36.5% NHW, 43.2% NHB, 20.2% HIS. History of hypertension (HTN), type II diabetes (DM II), smoking, heart failure (CHF), prior stroke, and end-stage renal disease varied significantly by race. Compared to NHW, NHB had higher odds of HTN (OR 2.28, 1.65–3.15), CHF (OR 2.17, 1.06–4.46), and DM II 1.92 (1.25–2.94) while HIS had higher odds of DM II (OR 2.52, 1.55–4.10) and lower odds of smoking (OR 0.56, 0.35–0.90). Arrival NIHSS was higher in NHB, but etiology and rates of tpA treatment and thrombectomy did not vary by race. Compared to NHW patients, NHB (OR 0.50 CI (0.31–0.78)) and HIS (OR 0.37 CI (0.21–0.67)) were less likely to have good functional outcome (mRS <2) at day 7 in adjusted analyses. Conclusions: In this study, there was a higher prevalence of several modifiable risk factors in NHB and HIS young stroke patients and early functional outcome was worse in these groups. Our study suggests a need for targeted prevention efforts for younger populations at highest risk for stroke.
KW - Disparities
KW - Epidemiology
KW - Functional recovery
KW - Ischemic stroke
KW - Race and ethnicity
KW - Risk factors
KW - Stroke
KW - Young
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U2 - 10.1016/j.jstrokecerebrovasdis.2020.104987
DO - 10.1016/j.jstrokecerebrovasdis.2020.104987
M3 - Article
C2 - 32689593
AN - SCOPUS:85086471411
SN - 1052-3057
VL - 29
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 8
M1 - 104987
ER -