African Americans and Women Have the Highest Stroke Mortality in Texas

Abstract-The 1994 to 1997 administrative data on 40 450 elderly Medicare beneficiaries and general population of 2 states were used to measure "case mortality" (deaths attributable to any cause among cases of acute stroke), "case fatality" (deaths caused by cerebrovascular diseases among cases of acute stroke), and "population mortality" (deaths caused by stroke in the elderly general population). Mortality was higher in men than in women according to all measures except population mortality caused by subarachnoid hemorrhage. There was no sex difference in 1-year case fatality. One-year all-cause mortality among cases of nonhemorrhagic stroke or all types of stroke was higher in men than in women. Similar sex differences were found in 4-year population mortality caused by nonhemorrhagic stroke or all types of stroke combined. The 3 measures differed with respect to sex difference in stroke mortality. How stroke is defined and how mortality is measured does affect sex difference. Key Words: measurement Ⅲ sex difference Ⅲ stroke mortality D isparity in the outcome of chronic diseases may be a useful indicator of an opportunity for improving preventive or therapeutic care. The natural history of stroke has been studied by many researchers who have found age, sex, and race differences in mortality.Some studies of stroke mortality did not find a significant sex difference 1-3 ; others found a relatively higher risk among men 4,5 or among women. 6 -8 Some of these investigations studied mortality associated with only 1 type of stroke. 5,7 Many investigations studied mortality from all types of stroke combined. Two of the 3 studies of sex difference in mortality caused by nonhemorrhagic stroke in the general population found increased risk among women, 6,8 whereas 2 of the 3 corresponding studies that measured case fatality rates among patients with acute stroke found increased risk among men. 4,5 There are many reasons for discrepancy between these studies with respect to the magnitude and the direction of sex difference in stroke mortality. This study addressed 2 factors-how stroke was defined and how mortality was measured-by estimating 3 different measures of sex-specific stroke mortality in the same geographically defined population during the same time period. The objective was to determine the effect of using different measures on sex difference in stroke mortality. Materials and MethodsThe measures of stroke mortality used in this study were (a) 1-year case mortality defined as deaths attributable to any cause among cases of acute stroke, (b) 1-year case fatality defined as deaths caused by cerebrovascular diseases among cases of acute stroke, and (c) 4-year population mortality defined as deaths caused by stroke in the general population in a 4-year period. The study cohort was 40 450 fee-for-service Medicare beneficiaries aged 65 to 99 years who were hospitalized in Indiana and Kentucky for acute stroke from January 1, 1994 to December 31, 1996. Medicare administrative data were used to identify the demograph...

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confidence: 99%

Effect of Measurement on Sex Difference in Stroke Mortality

Sheikh

Bullock

2007

“…6 Stroke mortality is higher in young MAs but reportedly lower in older MAs than in NHWs. 7,8 Risk factor profiles would predict higher stroke rates in MAs, 9 and indeed some have explained the lower stroke mortality in older MAs as a function of vital statistics error. 7,10 Intracerebral hemorrhage mortality is at least as high as that found in NHWs at all ages.…”

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confidence: 99%

Barriers to Acute Stroke Therapy and Stroke Prevention in Mexican Americans

Morgenstern¹,

Steffen²,

Smith³

et al. 2001

Self Cite

Background and Purpose-The purpose of this study was to identify specific targets to improve acute stroke treatment and stroke prevention in the Mexican American (MA) community. Methods-A professional, academic survey research team provided structured questions and elicited responses from 719 subjects identified by random-digit dialing in the biethnic community of Corpus Christi, Texas. This community of approximately 300 000 is approximately half MA and half non-Hispanic white (NHW). The cooperation rate for the survey was 58%. Results-MAs (nϭ357) were younger, less well educated, and had lower family income than NHWs (nϭ362, Pϭ0.001).MAs had a higher prevalence of diabetes mellitus (Pϭ0.001) but similar rates of hypertension, elevated cholesterol, and current tobacco use. MAs less commonly recognized that acute stroke therapy existed (Pϭ0.029), were less likely to acknowledge a time window for acute stroke treatment (Pϭ0.001), and were more reticent to say they would call 911 for stroke symptoms (Pϭ0.01) than NHWs. MAs were significantly less able to recall stroke symptoms and risk factors than NHWs. Only approximately 20% of both groups identified stroke as the No. 1 cause of disability. MAs expressed less confidence in their ability to prevent stroke (PϽ0.001), more distrust in the medical establishment (Pϭ0.007), and more concern that money impedes their seeking medical care (PϽ0.001). Conclusions-There are significant barriers to both acute stroke treatment and stroke prevention in MAs. This study identifies specific targets amenable for testing in an intervention project following confirmation by a methodology other than telephone survey.

“…7,12,25 These psychosocial and cultural differences may also foster a distrust of a NHW-run healthcare system, which may also explain both gender and race/ethnic differences. 4,18 Markedly increased delay times in hospital arrival and in evaluation by an emergency department physician was found in HA women presenting to the emergency room with acute stroke symptoms. 7 Similarly, these psychosocial norms may explain why women in New Mexico have a decreased knowledge of stroke risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…2,4,9 To prevent masking the interaction between age and ethnicity for stroke mortality, age adjustment was not used. 2,4 The stroke mortality rate for each race/ethnic group was calculated for the age-specific groups and by location. Rate ratios were calculated with NHW as the referent group, and 95% CIs were calculated by the Katz method.…”

Section: Methodsmentioning

confidence: 99%

“…1 An increasing need exists to understand race/ethnic differences in stroke for the purpose of designing effective public health intervention strategies. Only a handful of studies [2][3][4][5][6] have addressed race/ethnic differences in stroke mortality in the United States. In these studies, stroke mortality is consistently higher in African Americans (AAs) relative to non-Hispanic whites (NHWs).…”

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confidence: 99%

See 1 more Smart Citation

Race/Ethnicity and Location of Stroke Mortality

Wein

Smith²,

Morgenstern³

1999

Self Cite

Background and Purpose-Stroke community surveillance projects often focus on hospital data rates. We hypothesized that not including strokes which occurred in nursing homes or at home would differentially affect race/ethnic stroke rates. Methods-Texas vital statistics data were studied to compare age-specific (45 to 59, 60 to 74, and Ն75 years) location of stroke death for African Americans (AAs), Hispanic Americans (HAs), and non-Hispanic whites (NHWs). Rate ratios are reported with 95% CIs; NHW is used as the referent group. Results-During 1991 to 1996, there were 52 996 stroke deaths in Texas for individuals aged 45 years and older. HAs in the oldest age group (Ն75 years) were 33% more likely than NHWs to die in the hospital, and HAs aged 45 to 59 and 60 to 74 years were 4% and 10%, respectively, more likely to die in the hospital. AAs aged Ն75 years were 19% more likely to die in the hospital. HAs aged 60 to 74 years were 35% less likely to die in a nursing home, whereas HAs aged Ն75 years were 43% less likely than NHWs to die in a nursing home. AAs aged Ն75 were 33% less likely to die in a nursing home. Death at home was 19% more likely in HAs aged 60 to 74 years. Significant gender differences are also reported. Conclusions-Using hospital data alone would overestimate stroke mortality in the HA and AA groups. Stroke community surveillance projects should account for ethnic and gender differences in location of death to avoid bias in race/ethnic and gender comparisons. (Stroke. 1999;30:1501-1505.)