Tarko Laura, Costa Lauren, Galloway Ashley, Ho Yuk-Lam, Gagnon David, Lioutas Vasileios, Seshadri Sudha, Cho Kelly, Wilson Peter, Aparicio Hugo J
From the Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC) (L.T., L.C., A.G., Y.-L.H., D.G., V.L., S.S., K.C., H.J.A.), VA Boston Healthcare System; Department of Biostatistics (D.G.), Boston University School of Public Health; Department of Neurology (V.L.), Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Neurology (S.S., H.J.A.), Boston University School of Medicine, MA; Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases (S.S.), University of Texas Health San Antonio; Division of Aging (K.C.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; Atlanta VA Medical Center (P.W.), Decatur; Division of Cardiology (P.W.), Emory University School of Medicine; Department of Epidemiology (P.W.), Rollins School of Public Health, Emory University, Atlanta, GA; and Boston Medical Center (H.J.A.), MA.
Neurology. 2022 Jun 13;98(24):e2465-e2473. doi: 10.1212/WNL.0000000000200575.
Racial and ethnic disparities in stroke outcomes exist, but differences by stroke type are less understood. We studied the association of race and ethnicity with stroke mortality, by stroke type, in a national sample of hospitalized patients in the Veterans Health Administration.
A retrospective observational study was performed including non-Hispanic White, non-Hispanic Black, and Hispanic patients with a first hospitalization for stroke between 2002 and 2012. Stroke was determined using ICD-9 codes and date of death was obtained from the National Death Index. For each of acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), we constructed a piecewise multivariable model for all-cause mortality, using follow-up intervals of ≤30 days, 31-90 days, 91 days to 1 year, and >1 year.
Among 37,790 patients with stroke (89% AIS, 9% ICH, 2% SAH), 25,492 (67%) were non-Hispanic White, 9,752 (26%) were non-Hispanic Black, and 2,546 (7%) were Hispanic. The cohort was predominantly male (98%). Compared with White patients, Black patients experienced better 30-day survival after AIS (hazard ratio [HR] 0.80, 95% CI 0.73-0.88; 1.4% risk difference) and worse 30-day survival after ICH (HR 1.24, 95% CI 1.06-1.44; 3.2% risk difference). Hispanic patients experienced reduced risk for >1-year mortality after AIS (HR 0.87, 95% CI 0.80-0.94), but had greater risk of 30-day mortality after SAH compared with White patients (HR 1.61, 95% CI 1.03-2.52; 10.3% risk difference).
Among US Veterans, absolute risk of 30-day mortality after ICH was 3.2% higher for Black patients and after SAH was 10.3% higher for Hispanic patients compared with White patients. These findings underscore the importance of investigating stroke outcomes by stroke type to better understand the factors driving observed racial and ethnic disparities.
中风预后存在种族和民族差异，但不同中风类型的差异尚鲜为人知。我们在退伍军人健康管理局住院患者的全国样本中，按中风类型研究种族和民族与中风死亡率之间的关联。
进行了一项回顾性观察研究，纳入2002年至2012年间首次因中风住院的非西班牙裔白人、非西班牙裔黑人及西班牙裔患者。使用ICD - 9编码确定中风情况，并从国家死亡指数获取死亡日期。对于急性缺血性中风（AIS）、脑出血（ICH）和蛛网膜下腔出血（SAH）每种类型，我们构建了全因死亡率的分段多变量模型，随访间隔分为≤30天、31 - 90天、91天至1年以及>1年。
在37790例中风患者中（89%为AIS，9%为ICH，2%为SAH），25492例（67%）为非西班牙裔白人，9752例（26%）为非西班牙裔黑人，2546例（7%）为西班牙裔。该队列主要为男性（98%）。与白人患者相比，黑人患者在AIS后30天生存率更高（风险比[HR]0.80，95%置信区间0.73 - 0.88；风险差异1.4%），而在ICH后30天生存率更低（HR 1.24，95%置信区间1.06 - 1.44；风险差异3.2%）。西班牙裔患者在AIS后>1年死亡率风险降低（HR 0.87，95%置信区间0.80 - 0.94），但与白人患者相比，SAH后30天死亡率风险更高（HR 1.61，95%置信区间1.03 - 2.52；风险差异10.3%）。
在美国退伍军人中，与白人患者相比，黑人患者ICH后30天死亡率的绝对风险高3.2%，西班牙裔患者SAH后30天死亡率的绝对风险高10.3%。这些发现强调了按中风类型研究中风预后以更好理解导致观察到的种族和民族差异的因素的重要性。
