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(Stroke. 2000;31:563.)
© 2000 American Heart Association, Inc.
Original Contributions |
Racial Variation in Initial Stroke Severity
From the Epidemiologic Research and Information Center at Durham (R.D.H., S.B.A., E.Z.O.); the Center for Health Services Research in Primary Care (R.D.H., L.J.E., J.H., S.B.A., D.B.M., E.Z.O.) and Speech-Language Pathology Service (C.A.S.-H.), VA Medical Center; the Division of Biometry, Department of Community and Family Medicine (L.J.E.), and the Division of General Internal Medicine, Department of Medicine (R.D.H., C.A.S.-H., D.B.M., E.Z.O.), Duke University Medical Center; and the Center for Clinical Health Policy Research (D.B.M.), Duke University, Durham, NC. Correspondence to Ronnie D. Horner, PhD, HSR&D/ERIC (152), VA Medical Center, Building 16, Room 70, 508 Fulton St, Durham, NC 27705.
Background and Purpose—Blacks experience greater morbidity and mortality from stroke than do whites. The degree to which this is due to the severity of the initial stroke is not known. The objective of this study is to determine whether there is a racial difference in initial stroke severity.
Methods—A secondary analysis of a prospective cohort of 984 veterans (29.7% black) admitted to any of 9 geographically diverse Veterans Administration Hospitals for acute stroke between April 1995 and March 1997 was performed. Initial stroke severity was ascertained by using the modified Canadian Neurological Scale (CNS) applied retrospectively to medical record data. Stroke severity, unadjusted and adjusted for covariates, was compared between black and white patients.
Results—Blacks had greater initial stroke severity than did whites (mean CNS score 7.96 versus 8.32, respectively; P=0.039), with a 0.5-point difference on the scale corresponding to a single-level decrement in either speech or strength of half of an extremity. This difference persisted with adjustment for other important predictors of stroke severity (P=0.035). However, there was no significant racial difference in severity when CNS scores were collapsed into a priori clinically relevant categories.
Conclusions—Compared with whites, blacks show greater severity of stroke at hospital admission. It remains uncertain whether the relatively small but significant difference at presentation fully explains the striking racial differences in morbidity and mortality from stroke.
Key Words: blacks • cerebrovascular disorders • disease severity
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