From the Department of Neurology and Rehabilitation Medicine (D.R., R.J.S., M.H., L.N., P.K., J.P.B., S.F., D.W., M.L.F., S.D., E.A.M., B.K.), University of Cincinnati, OH; Department of Biostatistics (L.D., J.C.K.), Cincinnati Children's Medical Center, OH; Department of Biostatistics (G.H.), University of Alabama at Birmingham School of Public Health, AL; Department of Emergency Medicine (H.S., K.B.W.), University of Cincinnati, OH; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, Miami; Department of Neurology (S.S.), University of Kansas Medical Center, Kansas City; Department of Neurology (M.S.), Soroka Medical Center, Beersheva, Israel; VA National TeleStroke Program (S.R.M.), Veterans Health Administration, Houston, TX; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.S.J.), Yale University, New Haven, CT; and Department of Neurology (D.K.), University of Michigan, Ann Arbor.
Neurology. 2024 Aug 13;103(3):e209653. doi: 10.1212/WNL.0000000000209653. Epub 2024 Jul 15.
Few studies have examined trends and disparities in long-term outcome after stroke in a representative US population. We used a population-based stroke study in the Greater Cincinnati Northern Kentucky region to examine trends and racial disparities in poststroke 5-year mortality.
All patients with acute ischemic strokes (AISs) and intracerebral hemorrhages (ICHs) among residents ≥20 years old were ascertained using ICD codes and physician-adjudicated using a consistent case definition during 5 periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, and 2015. Race was obtained from the medical record; only those identified as White or Black were included. Premorbid functional status was assessed using the modified Rankin Scale, with a score of 0-1 being considered "good." Mortality was assessed with the National Death Index. Trends and racial disparities for each subtype were analyzed with logistic regression.
We identified 8,428 AIS cases (19.3% Black, 56.3% female, median age 72) and 1,501 ICH cases (23.5% Black, 54.8% female, median age 72). Among patients with AIS, 5-year mortality improved after adjustment for age, race, and sex (53% in 1993/94 to 48.3% in 2015, overall effect of study year = 0.009). The absolute decline in 5-year mortality in patients with AIS was larger than what would be expected in the general population (5.1% vs 2.8%). Black individuals were at a higher risk of death after AIS (odds ratio [OR] 1.23, 95% CI 1.08-1.39) even after adjustment for age and sex, and this effect was consistent across study years. When premorbid functional status and comorbidities were included in the model, the primary effect of Black race was attenuated but race interacted with sex and premorbid functional status. Among male patients with a good baseline functional status, Black race remained associated with 5-year mortality (OR 1.4, 95% CI 1.1-1.7, = 0.002). There were no changes in 5-year mortality after ICH over time (64.4% in 1993/94 to 69.2% in 2015, overall effect of study year = 0.32).
Long-term survival improved after AIS but not after ICH. Black individuals, particularly Black male patients with good premorbid function, have a higher mortality after AIS, and this disparity did not change over time.
很少有研究在具有代表性的美国人群中考察中风后长期预后的趋势和差异。我们使用辛辛那提北部肯塔基地区的一项基于人群的中风研究，研究了中风后 5 年死亡率的趋势和种族差异。
通过 ICD 代码确定≥20 岁居民中所有急性缺血性中风（AIS）和颅内出血（ICH）患者，并通过一致的病例定义由医生进行裁决。研究分为 5 个时期：1993 年 7 月至 1994 年 6 月和 1999 年、2005 年、2010 年和 2015 年的历年。种族从病历中获得；仅包括被认定为白种人或黑种人的患者。使用改良 Rankin 量表评估发病前的功能状态，得分 0-1 被认为是“良好”。使用国家死亡指数评估死亡率。使用逻辑回归分析每种亚型的趋势和种族差异。
我们共确定了 8428 例 AIS 病例（19.3%为黑人，56.3%为女性，中位年龄 72 岁）和 1501 例 ICH 病例（23.5%为黑人，54.8%为女性，中位年龄 72 岁）。在 AIS 患者中，调整年龄、种族和性别后，5 年死亡率有所改善（1993/94 年的 53%降至 2015 年的 48.3%，研究年份的总体效应 = 0.009）。AIS 患者 5 年死亡率的绝对下降幅度大于一般人群的预期（5.1%对 2.8%）。即使在调整了年龄和性别后，黑人个体在 AIS 后死亡的风险仍然更高（比值比 [OR] 1.23，95%CI 1.08-1.39），而且这种影响在各研究年份中是一致的。当将发病前的功能状态和合并症纳入模型时，黑人种族的主要影响减弱，但种族与性别和发病前的功能状态相互作用。在基线功能状态良好的男性患者中，黑人种族与 5 年死亡率相关（OR 1.4，95%CI 1.1-1.7， = 0.002）。ICH 后 5 年死亡率随时间无变化（1993/94 年的 64.4%至 2015 年的 69.2%，研究年份的总体效应 = 0.32）。
AIS 后生存状况有所改善，但 ICH 后则没有。黑人个体，特别是发病前功能良好的黑人男性，在 AIS 后死亡率更高，而且这种差异没有随时间变化。
