Abstract 2602: Changing Ethnic Disparity in Ischemic Stroke Mortality in US Children after the STOP Trial
Objective: A prior report showed higher stroke mortality in U.S. black children compared to white children (1979-1998), a disparity likely due in part to sickle cell disease. We hypothesized that this disparity has diminished since the publication of the Stroke Prevention Trial in Sickle Cell Anemia (STOP) trial in 1998 demonstrating the efficacy of chronic blood transfusions for primary stroke prevention. Because most childhood strokes in the setting of sickle cell disease are ischemic, we would expect a greater impact on ethnic disparities in ischemic than hemorrhagic stroke.
Methods: We evaluated the demographics and secular trends in mortality from ischemic and hemorrhagic stroke in U.S. children <20 years of age, using death certificate data from the National Center of Health Statistics (NCHS) from 1988 to 2007.
Results: A total of 1,555,045,537 person-years were included in the study. There were 4,425 deaths attributed to childhood stroke (as primary cause of death) within this cohort, yielding an average of 221 deaths per year. Ischemic strokes accounted for 20% of deaths; hemorrhagic strokes accounted for 67% (12% were unspecified). The relative risk of ischemic stroke mortality for black versus white children from 1988 to 1998 was 1.74 (95% CI 1.42-2.13, p<0.001) while the relative risk from 1999 to 2007 was 1.27 (95%CI 0.99-1.64, p= 0.063). While ischemic stroke mortality rates in black versus white children appear to be converging, the ethnic disparity in hemorrhagic stroke mortality has remained relatively stable (Figure 1).
Conclusion: The excess risk of death from ischemic, but not hemorrhagic, stroke in U.S. black children has decreased over the past decade. This may be related to the implementation of an effective primary stroke prevention strategy for children with sickle cell disease.
- © 2012 by American Heart Association, Inc.