| Title | Racial and ethnic differences in outcomes in older patients with acute ischemic stroke |
| Publication Type | Journal Article |
| Year of Publication | 2013 |
| Authors | Qian, F, Fonarow, GC, Smith, EE, Xian, Y, Pan, W, Hannan, EL, Shaw, BA, Glance, LG, Peterson, ED, Eapen, ZJ, Hernandez, AF, Schwamm, LH, Bhatt, DL |
| Journal | Circ Cardiovasc Qual OutcomesCirc Cardiovasc Qual OutcomesCirc Cardiovasc Qual Outcomes |
| Volume | 6 |
| Pagination | 284-92 |
| Date Published | May 1 |
| ISBN Number | 1941-7705 (Electronic)<br/>1941-7713 (Linking) |
| Accession Number | 23680966 |
| Keywords | African Americans/statistics & numerical data, Age Factors, Aged, Aged, 80 and Over, Brain Ischemia/diagnosis/ ethnology/mortality/ therapy, Continental Population Groups/ statistics & numerical data, Ethnic Groups/ statistics & numerical data, European Continental Ancestry Group/statistics & numerical data, Female, Health Status Disparities, Healthcare Disparities/ethnology, Hispanic Americans/statistics & numerical data, Humans, Logistic Models, Male, Medicare, Multivariate Analysis, Odds Ratio, Patient Readmission, Registries, Risk Factors, Severity of Illness Index, Stroke/diagnosis/ ethnology/mortality/ therapy, Time Factors, Treatment Outcome, United States/epidemiology |
| Abstract | BACKGROUND: Little is known as to whether long-term outcomes of acute ischemic stroke (AIS) vary by race/ethnicity. Using the American Heart Association Get With The Guidelines-Stroke registry linked with Medicare claims data set, we examined whether 30-day and 1-year outcomes differed by race/ethnicity among older patients with AIS. METHODS AND RESULTS: We analyzed 200 900 patients with AIS >65 years of age (170 694 non-Hispanic whites, 85.0%; 20 514 non-Hispanic blacks, 10.2%; 6632 Hispanics, 3.3%; 3060 non-Hispanic Asian Americans, 1.5%) from 926 US centers participating in the Get With The Guidelines-Stroke program from April 2003 through December 2008. Compared with whites, other racial and ethnic groups were on average younger and had a higher median score on the National Institutes of Health Stroke Scale. Whites had higher 30-day unadjusted mortality than other groups (white versus black versus Hispanic versus Asian=15.0% versus 9.9% versus 11.9% versus 11.1%, respectively). Whites also had higher 1-year unadjusted mortality (31.7% versus 28.6% versus 28.1% versus 23.9%, respectively) but lower 1-year unadjusted all-cause rehospitalization (54.7% versus 62.5% versus 60.0% versus 48.6%, respectively). After risk adjustment, Asian American patients with AIS had lower 30-day and 1-year mortality than white, black, and Hispanic patients. Relative to whites, black and Hispanic patients had higher adjusted 1-year all-cause rehospitalization (black: adjusted odds ratio, 1.28 [95% confidence interval, 1.21-1.37]; Hispanic: adjusted odds ratio, 1.22 [95% confidence interval, 1.11-1.35]), whereas Asian patients had lower odds (adjusted odds ratio, 0.83 [95% confidence interval, 0.74-0.94]). CONCLUSIONS: Among older Medicare beneficiaries with AIS, there were significant differences in long-term outcomes by race/ethnicity, even after adjustment for stroke severity, other prognostic variables, and hospital characteristics. |
| Short Title | Circulation. Cardiovascular quality and outcomesCirculation. Cardiovascular quality and outcomes |
| Alternate Journal | Circulation. Cardiovascular quality and outcomes |
Ethno Med: