Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality

Karen C. Albright, Lei Huang, Justin Blackburn, George Howard, Michael Mullen, Vera Bittner, Paul Muntner, Virginia Howard

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To determine black-white differences in 1-year recurrent stroke and 30-day case fatality after a recurrent stroke in older US adults. METHODS: We conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries with fee-for-service health insurance coverage who were hospitalized for ischemic stroke between 1999 and 2013. Hazard ratios for recurrent ischemic stroke and risk ratios for 30-day case fatality comparing blacks to whites were calculated with adjustment for demographics, risk factors, and competing risk of death when appropriate. RESULTS: Among 128,789 Medicare beneficiaries having an ischemic stroke (mean age 80 years [SD 8 years], 60.4% male), 11.1% were black. The incidence rate of recurrent ischemic stroke per 1,000 person-years for whites and blacks was 108 (95% confidence interval [CI], 106-111) and 154 (95% CI 147-162) , respectively. The multivariable-adjusted hazard ratio for recurrent stroke among blacks compared with whites was 1.36 (95% CI 1.29-1.44). The case fatality after recurrent stroke for blacks and whites was 21% (95% CI 21%-22%) and 16% (95% CI 15%-18%), respectively. The multivariable-adjusted relative risk for mortality within 30 days of a recurrent stroke among blacks compared with whites was 0.82 (95% CI 0.73-0.93). CONCLUSION: The risk of stroke recurrence among older Americans hospitalized for ischemic stroke is higher for blacks compared to whites, while 30-day case fatality after recurrent stroke remains lower for blacks.

Original languageEnglish (US)
Pages (from-to)e1741-e1750
JournalNeurology
Volume91
Issue number19
DOIs
StatePublished - Nov 6 2018
Externally publishedYes

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Stroke
Confidence Intervals
Medicare
Fee-for-Service Plans
Insurance Coverage
Health Insurance
Cohort Studies
Retrospective Studies
Odds Ratio
Demography
Recurrence
Mortality
hydroquinone
Incidence

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Albright, K. C., Huang, L., Blackburn, J., Howard, G., Mullen, M., Bittner, V., ... Howard, V. (2018). Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality. Neurology, 91(19), e1741-e1750. https://doi.org/10.1212/WNL.0000000000006467

Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality. / Albright, Karen C.; Huang, Lei; Blackburn, Justin; Howard, George; Mullen, Michael; Bittner, Vera; Muntner, Paul; Howard, Virginia.

In: Neurology, Vol. 91, No. 19, 06.11.2018, p. e1741-e1750.

Research output: Contribution to journalArticle

Albright, KC, Huang, L, Blackburn, J, Howard, G, Mullen, M, Bittner, V, Muntner, P & Howard, V 2018, 'Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality', Neurology, vol. 91, no. 19, pp. e1741-e1750. https://doi.org/10.1212/WNL.0000000000006467
Albright, Karen C. ; Huang, Lei ; Blackburn, Justin ; Howard, George ; Mullen, Michael ; Bittner, Vera ; Muntner, Paul ; Howard, Virginia. / Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality. In: Neurology. 2018 ; Vol. 91, No. 19. pp. e1741-e1750.
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