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Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables.

Publication ,  Journal Article
Johnson, NX; Marquine, MJ; Flores, I; Umlauf, A; Baum, CM; Wong, AWK; Young, AC; Manly, JJ; Heinemann, AW; Magasi, S; Heaton, RK
Published in: J Int Neuropsychol Soc
September 2017

OBJECTIVES: The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS: One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS: An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS: We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).

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Published In

J Int Neuropsychol Soc

DOI

EISSN

1469-7661

Publication Date

September 2017

Volume

23

Issue

8

Start / End Page

640 / 652

Location

England

Related Subject Headings

  • White People
  • Stroke
  • Neuropsychological Tests
  • Middle Aged
  • Male
  • Insurance, Health
  • Humans
  • Health Literacy
  • Female
  • Experimental Psychology
 

Citation

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Johnson, N. X., Marquine, M. J., Flores, I., Umlauf, A., Baum, C. M., Wong, A. W. K., … Heaton, R. K. (2017). Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc, 23(8), 640–652. https://doi.org/10.1017/S1355617717000480
Johnson, Neco X., Maria J. Marquine, Ilse Flores, Anya Umlauf, Carolyn M. Baum, Alex W. K. Wong, Alexis C. Young, et al. “Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables.J Int Neuropsychol Soc 23, no. 8 (September 2017): 640–52. https://doi.org/10.1017/S1355617717000480.
Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, et al. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc. 2017 Sep;23(8):640–52.
Johnson, Neco X., et al. “Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables.J Int Neuropsychol Soc, vol. 23, no. 8, Sept. 2017, pp. 640–52. Pubmed, doi:10.1017/S1355617717000480.
Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, Young AC, Manly JJ, Heinemann AW, Magasi S, Heaton RK. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc. 2017 Sep;23(8):640–652.
Journal cover image

Published In

J Int Neuropsychol Soc

DOI

EISSN

1469-7661

Publication Date

September 2017

Volume

23

Issue

8

Start / End Page

640 / 652

Location

England

Related Subject Headings

  • White People
  • Stroke
  • Neuropsychological Tests
  • Middle Aged
  • Male
  • Insurance, Health
  • Humans
  • Health Literacy
  • Female
  • Experimental Psychology