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Racial and ethnic differences in outcomes in older patients with acute ischemic stroke.

Publication ,  Journal Article
Qian, F; Fonarow, GC; Smith, EE; Xian, Y; Pan, W; Hannan, EL; Shaw, BA; Glance, LG; Peterson, ED; Eapen, ZJ; Hernandez, AF; Schwamm, LH; Bhatt, DL
Published in: Circ Cardiovasc Qual Outcomes
May 1, 2013

BACKGROUND: Little is known as to whether long-term outcomes of acute ischemic stroke (AIS) vary by race/ethnicity. Using the American Heart Association Get With The Guidelines-Stroke registry linked with Medicare claims data set, we examined whether 30-day and 1-year outcomes differed by race/ethnicity among older patients with AIS. METHODS AND RESULTS: We analyzed 200 900 patients with AIS >65 years of age (170 694 non-Hispanic whites, 85.0%; 20 514 non-Hispanic blacks, 10.2%; 6632 Hispanics, 3.3%; 3060 non-Hispanic Asian Americans, 1.5%) from 926 US centers participating in the Get With The Guidelines-Stroke program from April 2003 through December 2008. Compared with whites, other racial and ethnic groups were on average younger and had a higher median score on the National Institutes of Health Stroke Scale. Whites had higher 30-day unadjusted mortality than other groups (white versus black versus Hispanic versus Asian=15.0% versus 9.9% versus 11.9% versus 11.1%, respectively). Whites also had higher 1-year unadjusted mortality (31.7% versus 28.6% versus 28.1% versus 23.9%, respectively) but lower 1-year unadjusted all-cause rehospitalization (54.7% versus 62.5% versus 60.0% versus 48.6%, respectively). After risk adjustment, Asian American patients with AIS had lower 30-day and 1-year mortality than white, black, and Hispanic patients. Relative to whites, black and Hispanic patients had higher adjusted 1-year all-cause rehospitalization (black: adjusted odds ratio, 1.28 [95% confidence interval, 1.21-1.37]; Hispanic: adjusted odds ratio, 1.22 [95% confidence interval, 1.11-1.35]), whereas Asian patients had lower odds (adjusted odds ratio, 0.83 [95% confidence interval, 0.74-0.94]). CONCLUSIONS: Among older Medicare beneficiaries with AIS, there were significant differences in long-term outcomes by race/ethnicity, even after adjustment for stroke severity, other prognostic variables, and hospital characteristics.

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Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

May 1, 2013

Volume

6

Issue

3

Start / End Page

284 / 292

Location

United States

Related Subject Headings

  • White People
  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Severity of Illness Index
  • Risk Factors
  • Registries
  • Racial Groups
  • Patient Readmission
 

Citation

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Qian, F., Fonarow, G. C., Smith, E. E., Xian, Y., Pan, W., Hannan, E. L., … Bhatt, D. L. (2013). Racial and ethnic differences in outcomes in older patients with acute ischemic stroke. Circ Cardiovasc Qual Outcomes, 6(3), 284–292. https://doi.org/10.1161/CIRCOUTCOMES.113.000211
Qian, Feng, Gregg C. Fonarow, Eric E. Smith, Ying Xian, Wenqin Pan, Edward L. Hannan, Benjamin A. Shaw, et al. “Racial and ethnic differences in outcomes in older patients with acute ischemic stroke.Circ Cardiovasc Qual Outcomes 6, no. 3 (May 1, 2013): 284–92. https://doi.org/10.1161/CIRCOUTCOMES.113.000211.
Qian F, Fonarow GC, Smith EE, Xian Y, Pan W, Hannan EL, et al. Racial and ethnic differences in outcomes in older patients with acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):284–92.
Qian, Feng, et al. “Racial and ethnic differences in outcomes in older patients with acute ischemic stroke.Circ Cardiovasc Qual Outcomes, vol. 6, no. 3, May 2013, pp. 284–92. Pubmed, doi:10.1161/CIRCOUTCOMES.113.000211.
Qian F, Fonarow GC, Smith EE, Xian Y, Pan W, Hannan EL, Shaw BA, Glance LG, Peterson ED, Eapen ZJ, Hernandez AF, Schwamm LH, Bhatt DL. Racial and ethnic differences in outcomes in older patients with acute ischemic stroke. Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):284–292.

Published In

Circ Cardiovasc Qual Outcomes

DOI

EISSN

1941-7705

Publication Date

May 1, 2013

Volume

6

Issue

3

Start / End Page

284 / 292

Location

United States

Related Subject Headings

  • White People
  • United States
  • Treatment Outcome
  • Time Factors
  • Stroke
  • Severity of Illness Index
  • Risk Factors
  • Registries
  • Racial Groups
  • Patient Readmission