Department of Neurology and Rehabilitation Medicine (D.J.R., R.S.K.A., M.H., S.F., E.A.M., S.D., D.W., B.K.), University of Cincinnati; Department of Biostatistics (H.S.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Miami Neuroscience Institute (F.d.l.R.l.R.), Baptist Health South Florida; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale University, New Haven, CT; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; Department of Neurology (S.S.), University of Kansas Medical Center Kansas City; Department of Emergency Medicine (K.W.), University of Cincinnati, OH; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor.
Neurology. 2022 Nov 29;99(22):e2464-e2473. doi: 10.1212/WNL.0000000000201225. Epub 2022 Aug 30.
There are significant racial disparities in stroke in the United States, with Black individuals having a higher risk of incident stroke even when adjusted for traditional stroke risk factors. It is unknown whether Black individuals are also at a higher risk of recurrent stroke.
Over an 18-month period spanning 2014-2015, we ascertained index stroke cases within the Greater Cincinnati/Northern Kentucky population of 1.3 million. We then followed up all patients for 3 years and determined the risk of recurrence. Multivariable survival analysis was performed to determine the effect of Black race on recurrence.
There were 3,816 patients with index stroke/TIA events in our study period, and 476 patients had a recurrent event within 3 years. The Kaplan-Meier estimate of 3-year recurrence rate was 15.4%. Age-adjusted and sex-adjusted stroke recurrence rate was higher in Black individuals (HR 1.34, 95% CI 1.1-1.6; = 0.003); however, when adjusted for traditional stroke risk factors including hypertension, diabetes, smoking status, age, and left ventricular hypertrophy, the association between Black race and recurrence was significantly attenuated and became nonsignificant (HR 1.1, 95% CI 0.9-1.36, = 0.32). At younger ages, Black race was more strongly associated with recurrence, and this effect may not be fully attenuated by traditional stroke risk factors.
Recurrent stroke was more common among Black individuals, but the magnitude of the racial difference was substantially attenuated and became nonsignificant when adjusted for traditional stroke risk factors. Interventions targeting these risk factors could reduce disparities in stroke recurrence.
在美国，中风存在显著的种族差异，即使调整了传统的中风风险因素，黑人个体发生中风的风险仍然更高。目前尚不清楚黑人个体是否也有更高的中风复发风险。
在 2014 年至 2015 年的 18 个月期间，我们确定了 130 万大辛辛那提/北肯塔基地区的中风/TIA 索引病例。然后，我们对所有患者进行了 3 年的随访，并确定了复发的风险。采用多变量生存分析来确定黑人种族对复发的影响。
在我们的研究期间，有 3816 例索引中风/TIA 事件患者，其中 476 例在 3 年内发生了复发事件。3 年复发率的 Kaplan-Meier 估计值为 15.4%。在调整了年龄和性别后，黑人个体的中风复发率更高（HR 1.34，95%CI 1.1-1.6； = 0.003）；然而，当调整了包括高血压、糖尿病、吸烟状况、年龄和左心室肥厚在内的传统中风风险因素后，黑人种族与复发之间的关联显著减弱且变得无统计学意义（HR 1.1，95%CI 0.9-1.36， = 0.32）。在较年轻的年龄，黑人种族与复发的关联更强，而这种效应可能不能被传统的中风风险因素完全减弱。
黑人个体中风复发更为常见，但在调整了传统的中风风险因素后，这种种族差异的幅度显著减弱且变得无统计学意义。针对这些风险因素的干预措施可能会减少中风复发的差异。
