Abstract 2207: Racial Disparities in Ischemic Stroke Mortality
Introduction---Stroke is more prevalent in blacks than whites. CDC data suggest age-adjusted mortality may be 3-fold higher in blacks. However, an analysis of the Get With The Guidelines-Stroke registry found a lower risk of in-hospital death in blacks. We hypothesized that black and white stroke patients differed in both in-hospital and longer term mortality, as well as in cause of death.
Methods---We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes demographic and clinical data on patients discharged with a primary diagnosis of cerebral infarction from all non-federal acute care hospitals in New Jersey between 1996 and 2007. Out-of-hospital deaths were assessed by matching MIDAS records with New Jersey death registration files. In-hospital, 1-year, and interval (discharge to 1-year) mortality were calculated. Total, cardiovascular disease (CVD), and non-CVD mortality were calculated. Multivariate logistic regression models were used to measure the effect of race on in-hospital, 1-year, and interval mortality after adjusting for demographics, comorbid conditions, hospital type, year of admission, and treatment. Statistical significance was defined as a P-value ≤ 0.05.
Results---123,326 patients were admitted with a primary diagnosis of cerebral infarction during the study period. Significant baseline differences existed between black and white stroke patients (Table). Intravenous tPA rates were low overall, but no difference existed between races (Black 1.29% versus White 1.39%, p=0.3) Overall, in-hospital and 1-year mortality rates were 6.5% and 18.9% for blacks and 9.3% and 26.9% for whites. After adjusting for available covariates, no significant difference was observed between races for in-hospital (OR = 1.00; 95% CI = 0.93 to 1.06), 1-year (OR = 0.99; 95% CI = 0.95 to 1.03), or interval (OR = 0.98; 95% CI = 0.93 to 1.03) mortality. Blacks were less likely to die in the hospital from CVD causes (OR = 0.66; 95% CI = 0.58 to 0.76). However, this racial disparity was no longer observed in deaths occurring in the year after discharge (OR = 0.94; 95% CI 0.86 to 1.03).
Conclusion---Black stroke patients in New Jersey are on average almost 10 years younger, more likely to be female, and have more comorbid conditions than their white counterparts. No difference was observed for adjusted in-hospital or 1-year mortality. Black patients are more likely to die from non-CVD related conditions during the initial hospitalization.
- © 2012 by American Heart Association, Inc.