Division of Stroke and Cerebrovascular Disease, Department of Neurology, Cedars-Sinai Medical Center, 127 S. San Vincente Blvd. #A6600, Los Angeles, CA, USA.
Division of Neurology Clinical Outcomes Research and Population Sciences (Neuro CORPS), Department of Neurology, Columbia University Medical Center, New York, NY, USA.
Sci Rep. 2022 Oct 3;12(1):16556. doi: 10.1038/s41598-022-20987-x.
A large portion of stroke disparities remains unexplained, even after adjusting for demographic, comorbidity, and health care access variables. There is a critical need to close this knowledge gap by investigating novel factors that may contribute to stroke disparities. Allostatic load (AL) is the lifetime adverse physiologic impact of needing to adjust to socially structured stressors such as racism. AL has been shown to increase health vulnerability and worsen outcomes in marginalized populations. We sought to assess the differential impact of AL on cognitive outcomes post intracerebral hemorrhage (ICH) across race-ethnicity. The Intracerebral Hemorrhage Outcomes Project (ICHOP) prospectively collected data from patients presenting to Columbia Medical Center with ICH from 3/2009 to 5/2016. Data included demographics, stroke scores, labs, complications, neuroimaging, medical history, and discharge data. Five markers of AL (HbA1c, WBC, SBP, HR, ALB) were obtained. An AL score was generated by summing the elements in each patient that fell outside normal ranges, with AL score ranging 0-5. A linear regression model, adjusted for stroke severity and ICH volumes, was used to evaluate the relationship between AL and Modified Telephone Interview for Cognitive Status (TICS-m) at discharge, stratified by race-ethnicity. Among 248 white, 195 black, and 261 Hispanic ICH patients, neither mean AL nor mean TICS differed by race/ethnicity (p = 0.51, p = 0.79 respectively). In the overall cohort AL did not predict TICS at discharge (Beta -1.0, SE 1.1, p = 0.353). In Whites (beta 1.18, SE 2.5, p = 0.646) and Hispanics (beta -0.95, SE 1.6, p = 0.552) AL was not associated with TICS at discharge. In Black patients, higher AL was associated with a decrease in TICS at discharge (beta -3.2, SE 1.5, p = 0.049). AL is an important determinant of post ICH outcomes for certain minority populations. AL may explain some of the unexplained health disparities in stroke populations.
尽管在调整了人口统计学、合并症和医疗保健获取变量后，大部分中风差异仍然无法解释。通过研究可能导致中风差异的新因素来填补这一知识空白至关重要。适应负荷（AL）是一生中需要适应社会结构压力源（如种族主义）的不利生理影响。AL 已被证明会增加弱势群体的健康脆弱性并恶化其预后。我们试图评估 AL 对不同种族-族裔间脑出血（ICH）后认知结果的差异影响。颅内出血结果项目（ICHOP）前瞻性地从 2009 年 3 月至 2016 年 5 月在哥伦比亚医疗中心就诊的 ICH 患者中收集数据。数据包括人口统计学、中风评分、实验室检查、并发症、神经影像学、病史和出院数据。获得了 5 个 AL 标志物（HbA1c、WBC、SBP、HR、ALB）。通过将每位患者超出正常范围的元素相加来生成 AL 评分，AL 评分范围为 0-5。使用调整了中风严重程度和 ICH 量的线性回归模型，按种族-族裔分层，评估 AL 与出院时改良电话认知状态测试（TICS-m）之间的关系。在 248 名白人、195 名黑人、261 名西班牙裔 ICH 患者中，AL 的平均值和 TICS 的平均值均与种族/族裔无关（p=0.51，p=0.79）。在整个队列中，AL 并不预示出院时的 TICS（β-1.0，SE1.1，p=0.353）。在白人（β1.18，SE2.5，p=0.646）和西班牙裔（β-0.95，SE1.6，p=0.552）中，AL 与出院时的 TICS 无关。在黑人患者中，较高的 AL 与出院时 TICS 的降低相关（β-3.2，SE1.5，p=0.049）。AL 是某些少数族裔人群脑出血后结局的重要决定因素。AL 可能解释了中风人群中一些无法解释的健康差异。
