Racial differences in mortality among patients with acute ischemic stroke: an observational study.
BACKGROUND: Black patients are commonly believed to have higher stroke mortality. However, several recent studies have reported better survival in black patients with stroke. OBJECTIVE: To examine racial differences in stroke mortality and explore potential reasons for these differences. DESIGN: Observational cohort study. SETTING: 164 hospitals in New York. PARTICIPANTS: 5319 black and 18 340 white patients aged 18 years or older who were hospitalized with acute ischemic stroke between January 2005 and December 2006. MEASUREMENTS: Influence of race on mortality, examined by using propensity score analysis. Secondary outcomes were selected aspects of end-of-life treatment, use of tissue plasminogen activator, hospital spending, and length of stay. Patients were followed for mortality for 1 year after admission. RESULTS: Overall in-hospital mortality was lower for black patients than for white patients (5.0% vs. 7.4%; P < 0.001), as was all-cause mortality at 30 days (6.1% vs. 11.4%; P < 0.001) and 1 year (16.5% vs. 24.4%; P < 0.001). After propensity score adjustment, black race was independently associated with lower in-hospital mortality (odds ratio [OR], 0.77 [95% CI, 0.61 to 0.98]) and all-cause mortality up to 1 year (OR, 0.86 [CI, 0.77 to 0.96]). The adjusted hazard ratio was 0.87 (CI, 0.79 to 0.96). After adjustment for the probability of dying in the hospital, black patients with stroke were more likely to receive life-sustaining interventions (OR, 1.22 [CI, 1.09 to 1.38]) but less likely to be discharged to hospice (OR, 0.25 [CI, 0.14 to 0.46]). LIMITATIONS: The study used hospital administrative data that lacked a stroke severity measure. The study design precluded determination of causality. CONCLUSION: Among patients with acute ischemic stroke, black patients had lower mortality than white patients. This could be the result of differences in receipt of life-sustaining interventions and end-of-life care.
Xian, Y; Holloway, RG; Noyes, K; Shah, MN; Friedman, B
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