From the Department of Epidemiology (L.D.L., E.C., M.K., M.A.S., L.B.M.), School of Public Health, and Stroke Program (L.D.L., D.L.B., D.B.Z., L.B.M.), University of Michigan, Ann Arbor.
Neurology. 2024 Dec 10;103(11):e210033. doi: 10.1212/WNL.0000000000210033. Epub 2024 Nov 12.
The objective of this study was to quantify trends (2008-2019) in stroke outcomes by race-ethnicity.
Patients with ischemic stroke from a population-based study were interviewed at 90 days to assess outcomes. Linear regression with multiple imputation and inverse probability weighting was used to model trends.
The median age was 66 years (n = 1,449); 61% were Mexican American (MA). QOL remained stable with no race-ethnic difference in trends ( for time*race-ethnicity interaction = 0.81). Neurologic outcomes improved for MA ( < 0.01) but not non-Hispanic White (NHW) persons with stroke ( = 0.23) with no race-ethnic difference in trends ( for interaction = 0.23). For functional outcomes, trends were stable and then improved in MA persons with stroke ( for interaction = 0.01), whereas trends were stable in NHW persons with stroke ( = 0.52). For cognitive outcomes, there was little change in NHW persons with stroke ( = 0.50); in MA persons with stroke, there was improvement followed by decline and then improvement ( = 0.03). No race-ethnic differences in trends in functional ( for interaction = 0.51) or cognitive ( for interaction = 0.21) outcomes were noted.
Outcome improvements were noted in MA but not NHW persons with stroke; race-ethnic differences were not present in 2019. Understanding factors contributing to favorable trends in MA persons may be informative for improving outcomes in all persons.
本研究旨在量化不同种族-民族间(2008-2019 年)的卒中结局趋势。
从一项基于人群的研究中选取缺血性卒中患者,于 90 天时对其进行访谈以评估结局。采用多元线性回归和逆概率加权进行模型趋势分析。
患者的中位年龄为 66 岁(n=1449),其中 61%为墨西哥裔美国人(MA)。生活质量(QOL)无变化,不同种族-民族间的趋势无差异( 时间*种族-民族交互作用=0.81)。MA 患者的神经功能结局有所改善( < 0.01),而非西班牙裔白人(NHW)患者则无改善( = 0.23),且不同种族-民族间的趋势无差异( 交互作用=0.23)。在功能结局方面,MA 患者的趋势稳定,随后有所改善( 交互作用=0.01),而 NHW 患者的趋势稳定( = 0.52)。认知结局方面,NHW 患者的变化不大( = 0.50);而 MA 患者则先是改善,随后下降,最后再次改善( = 0.03)。功能( 交互作用=0.51)或认知( 交互作用=0.21)结局方面未观察到不同种族-民族间的趋势差异。
MA 患者的结局有所改善,但 NHW 患者则无;2019 年时不同种族-民族间不存在差异。了解导致 MA 患者结局改善的因素,可能有助于改善所有患者的结局。