Johnson Neco X, Marquine Maria J, Flores Ilse, Umlauf Anya, Baum Carolyn M, Wong Alex W K, Young Alexis C, Manly Jennifer J, Heinemann Allen W, Magasi Susan, Heaton Robert K
1San Diego State University,Department of Psychology,San Diego,California.
2University of California,San Diego,Department of Psychiatry,San Diego,California.
J Int Neuropsychol Soc. 2017 Sep;23(8):640-652. doi: 10.1017/S1355617717000480. Epub 2017 Jun 29.
The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke.
One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale.
An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment.
We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).
本研究使用美国国立卫生研究院工具箱认知电池（NIHTB-CB），考察非西班牙裔黑人和白人中风幸存者在神经认知结果上的差异，并探讨医疗保健变量在解释中风后神经认知结果种族差异中的作用。
纳入170名参与多中心研究的成年人（91名黑人；79名白人）（年龄：M = 56.4；标准差 = 12.6；受教育程度：M = 13.7；标准差 = 2.5；50%为男性；中风后年限：1 - 18年；中风类型：72%为缺血性，28%为出血性）。使用经人口统计学校正的常模，通过NIHTB-CB评估神经认知功能。参与者完成了社会人口学特征、健康素养以及医疗保健使用和可及性的测量。使用改良Rankin量表评估中风严重程度。
独立样本t检验表明，黑人比白人表现出更多的神经认知障碍（NIHTB-CB流体综合T分数：M = 37.63；标准差 = 11.67）（流体T分数：M = 42.59，标准差 = 11.54；p = 0.006）。在调整阅读水平（NIHTB-CB口头阅读）后以及按中风严重程度分层时，这种差异仍然显著。黑人在健康素养方面得分也较低，报告了保险类型的差异，并表示对治疗他们的医生信心降低。调整阅读水平和损伤严重程度的多变量模型表明，健康素养和保险类型是流体认知综合指标的统计学显著预测因素（分别为p < 0.001和p = 0.02），并显著介导了神经认知障碍的种族差异。
我们重复了先前的研究结果，表明黑人中风后神经认知结果较差的风险高于白人。健康素养和保险类型可能是影响这些差异的重要可改变因素。（《神经心理学杂志》，2017年，第23卷，第640 - 652页）
