Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States.
Institute for Stroke and Cerebrovascular Disease, University Health Sciences Center at Houston, 6431 Fannin Street. MSB 7.044, Houston, TX 77030-1501, United States.
J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104987. doi: 10.1016/j.jstrokecerebrovasdis.2020.104987. Epub 2020 Jun 14.
Recent studies show rising incidence of stroke in the young, for which risk factors are not well characterized. There is evidence of increased risk in certain racial and ethnic groups. We assessed racial differences in risk factors, stroke etiology, and outcomes among young stroke patients.
Using data from our inpatient registry for ischemic stroke, we reviewed patients aged 18-50 who were admitted 01/2013 to 04/2018. Race/ethnicity were characterized as non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic (HIS). For univariate comparisons Chi-square and Kruskal-Wallis tests were performed as appropriate. Multivariable logistic regression was used to assess impact of race on day seven modified Rankin score (mRS).
Among 810 patients with race and outcome data who were admitted in the study period, median age was 43, 57.1% were male, and 36.5% NHW, 43.2% NHB, 20.2% HIS. History of hypertension (HTN), type II diabetes (DM II), smoking, heart failure (CHF), prior stroke, and end-stage renal disease varied significantly by race. Compared to NHW, NHB had higher odds of HTN (OR 2.28, 1.65-3.15), CHF (OR 2.17, 1.06-4.46), and DM II 1.92 (1.25-2.94) while HIS had higher odds of DM II (OR 2.52, 1.55-4.10) and lower odds of smoking (OR 0.56, 0.35-0.90). Arrival NIHSS was higher in NHB, but etiology and rates of tpA treatment and thrombectomy did not vary by race. Compared to NHW patients, NHB (OR 0.50 CI (0.31-0.78)) and HIS (OR 0.37 CI (0.21-0.67)) were less likely to have good functional outcome (mRS <2) at day 7 in adjusted analyses.
In this study, there was a higher prevalence of several modifiable risk factors in NHB and HIS young stroke patients and early functional outcome was worse in these groups. Our study suggests a need for targeted prevention efforts for younger populations at highest risk for stroke.
最近的研究表明，年轻人中风的发病率正在上升，但目前尚不清楚其危险因素。某些种族和族裔群体的风险增加已得到证实。我们评估了年轻中风患者的危险因素、中风病因和结局的种族差异。
利用我们缺血性中风住院患者登记处的数据，我们回顾了 2013 年 1 月至 2018 年 4 月期间入院的年龄在 18-50 岁的患者。种族/族裔被描述为非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）、西班牙裔（HIS）。对于单变量比较，使用了适当的卡方检验和克鲁斯卡尔-沃利斯检验。多变量逻辑回归用于评估种族对第 7 天改良 Rankin 评分（mRS）的影响。
在研究期间入院并具有种族和结局数据的 810 名患者中，中位年龄为 43 岁，57.1%为男性，36.5%为 NHW，43.2%为 NHB，20.2%为 HIS。高血压（HTN）、2 型糖尿病（DM II）、吸烟、心力衰竭（CHF）、既往中风和终末期肾病的病史因种族而异。与 NHW 相比，NHB 患 HTN（OR 2.28，1.65-3.15）、CHF（OR 2.17，1.06-4.46）和 DM II（OR 1.92，1.25-2.94）的几率更高，而 HIS 患 DM II（OR 2.52，1.55-4.10）的几率更高，吸烟（OR 0.56，0.35-0.90）的几率更低。NHB 的入院 NIHSS 较高，但病因和 tpA 治疗及血栓切除术的比例不因种族而异。与 NHW 患者相比，NHB（OR 0.50，95%CI（0.31-0.78））和 HIS（OR 0.37，95%CI（0.21-0.67））在调整后的分析中第 7 天具有良好的功能结局（mRS<2）的可能性较小。
在这项研究中，NHB 和 HIS 的年轻中风患者中存在更高比例的几种可改变的危险因素，并且这些组的早期功能结局更差。我们的研究表明，需要针对风险最高的年轻人群进行有针对性的预防工作。
