From the Stroke Program (J.F.B., L.D.L., D.L.B., L.E.S.), Institute for Social Research (V.A.F.), and Departments of Epidemiology (L.D.L.) and Emergency Medicine (A.H.), University of Michigan, Ann Arbor.
Neurology. 2014 Jul 29;83(5):390-7. doi: 10.1212/WNL.0000000000000640. Epub 2014 Jun 27.
We sought to characterize racial differences in disability among older stroke survivors.
A cross-sectional study of 806 self-reported stroke survivors from the 2011 National Health and Aging Trends Study was performed. Race was based on self-report. Primary outcome was activity limitations (requiring assistance with mobility, self-care, and household activities). Secondary outcome was participation restrictions, which were defined as reductions/absence in valued social activities because of health. Physical capacity was measured by a validated scale (0 low-12 high). Logistic regression was used to estimate average marginal effects of activity limitations and participation restrictions by race before and after adjusting for sociodemographics, comorbidities, and physical and cognitive capacity.
Non-Hispanic black participants had lower physical capacity than non-Hispanic white participants (mean 5.1 vs 6.9, p < 0.01). For most activities, black participants had significantly greater limitations than white participants. These differences persisted after accounting for sociodemographic factors and comorbidities, but largely became nonsignificant after accounting for physical capacity. The only unadjusted racial difference in participation restriction was in religious service attendance (18.2% of white participants vs 28.6% of black participants, p < 0.01).
After stroke, black individuals have a greater prevalence of activity limitations than white individuals, largely due to their greater physical capacity limitations. Further understanding of the causes of racial differences in capacity after stroke is needed to reduce activity limitations after stroke and decrease racial disparities.
本研究旨在描述老年脑卒中幸存者的残疾种族差异特征。
本研究为横断面研究，共纳入 2011 年国家健康老龄化趋势研究中的 806 例自我报告脑卒中幸存者。种族基于自我报告。主要结局指标为活动受限（需要他人协助移动、自我护理和家务活动）。次要结局指标为参与受限，其定义为由于健康原因减少/无法参加有价值的社会活动。身体能力通过验证量表（0 表示低，12 表示高）进行测量。使用逻辑回归估计种族对活动受限和参与受限的平均边际效应，在调整社会人口统计学因素、合并症和身体及认知能力后进行分析。
非西班牙裔黑人参与者的身体能力低于非西班牙裔白人参与者（平均 5.1 分 vs 6.9 分，p < 0.01）。对于大多数活动，黑人参与者的受限程度明显高于白人参与者。这些差异在考虑社会人口统计学因素和合并症后仍然存在，但在考虑身体能力后大部分变得无统计学意义。在参与限制方面，唯一未经调整的种族差异是宗教服务的参与（18.2%的白人参与者和 28.6%的黑人参与者，p < 0.01）。
脑卒中后，黑人个体的活动受限比白人个体更为普遍，这主要归因于他们身体能力受限更为严重。需要进一步了解脑卒中后导致种族间身体能力差异的原因，以减少脑卒中后的活动受限，缩小种族差异。
