Racial disparities in severity of cerebrovascular events.

Kuhlemeier, K.V.; Stiens, Steven A.

doi:10.1161/01.str.25.11.2126

Cited by 53 publications

(38 citation statements)

References 30 publications

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“…In multivariable analyses adjusting for ICH risk factors, NHPI race was an independent predictor of young ICH. The age disparity seen in our study is similar to the age disparities reported in other ICH observational studies comparing non-Hispanic white subjects to Maoris from New Zealand, 20 Mexican Americans, 21 and black patients 22,23 with ICH, and supports the idea that minority racial groups have a significantly younger age at presentation with ICH. Since NHPI have been historically grouped with Asians into a single racial category in many studies, prior ICH studies may have masked substantial differences in disease characteristics and outcomes among the NHPI group.…”

Section: Discussionsupporting

confidence: 89%

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

Nakagawa

Koenig²,

Seto³

et al. 2012

Neurology

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Objectives: To evaluate disparities in stroke risk factors and outcome among the Native Hawaiians and other Pacific Islanders (NHPI) in Hawaii who are hospitalized with intracerebral hemorrhage (ICH). Methods:We performed a retrospective study on consecutive patients hospitalized for acute ICH at a single tertiary center on Oahu between 2004 and 2010. Clinical data were obtained from the Get With the Guidelines-Stroke database. Multivariable logistic regression was used to assess the predictors for young ICH (age Ͻ45).Results: A total of 562 patients hospitalized for acute ICH (Asian 63%, NHPI 18%, white 16%, other 3%) were studied. The NHPI were younger (mean ages, NHPI 55 Ϯ 16 vs white 66 Ϯ 16 years, p Ͻ 0.0001), and had higher prevalence of diabetes (NHPI 35% vs white 20%, p ϭ 0.01) and history of hypertension (NHPI 77% vs white 64%, p ϭ 0.04) compared to white patients. Independent predictors for young ICH were NHPI race (odds ratio [OR] Conclusions: NHPI with ICH are younger and have higher burden of risk factors compared to white patients. Further studies controlling for socioeconomic modifiers are needed to determine factors contributing to the younger age at presentation in this racial group. Neurology ® 2012;79:675-680 GLOSSARY BMI ϭ body mass index; CAD ϭ coronary artery disease; CI ϭ confidence interval; GWTG ϭ Get With the Guidelines; HDL ϭ high-density lipoprotein; ICH ϭ intracerebral hemorrhage; IVH ϭ intraventricular hemorrhage; LDL ϭ low-density lipoprotein; LOS ϭ length of stay; MI ϭ myocardial infarction; NHPI ϭ Native Hawaiians and other Pacific Islanders; OR ϭ odds ratio; QMC ϭ Queen's Medical Center.Intracerebral hemorrhage (ICH) accounts for 10%-15% of the approximately 700,000 annual strokes in the Unites States 1 and results in disproportionately high morbidity and mortality. 2 In Hawaii, the age-adjusted incidence of ICH is estimated to be 0.6/1,000 person-years 3 in a population that consists of 25% white subjects, 39% Asians, and 10% Native Hawaiians and other Pacific Islanders (NHPI) compared to 0.3/1,000 person-years in a population in Northern Manhattan that consists of 23% white subjects, 12% black subjects, and 65% Hispanic subjects. 4 Recent evidence suggests that the burden of ICH is not borne equally by all, with racial minority groups reported to have a higher incidence and poorer outcomes than white subjects. [5][6][7] Although NHPI have been reported to have higher prevalence of major cardiovascular risk factors 8 -13 and die at a younger age from various cardiovascular diseaserelated complications compared to other major racial-ethnic groups, 14,15 the specific disease burden related to ICH in this population has not been studied. We hypothesized that NHPI with ICH are younger and have higher burden of risk factors compared to non-Hispanic white subjects.

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Section: Discussionsupporting

confidence: 89%

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

Nakagawa

Koenig²,

Seto³

et al. 2012

Neurology

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“…This may be driven by a disproportionate number of severe strokes from minority patients within these hospitals. 22,23 However, our findings demonstrate that increased risks associated with these hospitals affect all racial and ethnic groups. For example, white patients treated in hospitals with the highest black/Hispanic admission rates have a 2% absolute increase in the adjusted probability of feeding tube placement compared to those treated in hospitals with the lowest rates.…”

mentioning

confidence: 57%

“…These findings may be at least partly driven by greater stroke severity 22,23 and a greater number of clinically eligible minority patients. However, these differences may also result from diversity in preferences or disparities in how providers and institutions interpret these preferences.…”

mentioning

confidence: 99%

Current practices in feeding tube placement for US acute ischemic stroke inpatients

et al. 2014

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“…41 Evidence from US-based studies reveals a direct relationship between stroke severity and other contributory factors such as in-hospital mortality, duration of stay, poor Glasgow Coma Scale score, and incontinence during acute presentation. 42 Although the Leicestershire Stroke Study reported a significant association between development of incontinence during the acute stage and 28-day stroke morbidity in South Asians, there is limited information on the impact of South Asian ethnicity on stroke severity. …”

Section: Predictors Of Stroke Severity In South Asiansmentioning

confidence: 99%

Ischemic Stroke in South Asians

Gunarathne

Patel

Gammon

et al. 2009

Stroke

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Background and Purpose-Within the United Kingdom, mortality from stroke is higher among South Asians compared to European whites. The reasons for this excess cerebrovascular risk in South Asians remain unclear. The aim of this review is to present a comprehensive and systematic overview of the available literature relating to ischemic stroke among South Asian populations identifying distinct features of stroke epidemiology in this group. Summary of Review-A high frequency of lacunar strokes is a familiar pattern among South Asians, which suggests a greater prevalence of small-vessel disease in South Asians. This may be a consequence of abnormal metabolic and glycemic processes. In addition, stroke mortality among South Asians appears to be explained by glycemic status, which is an independent predictor of long-term stroke mortality. Within India, there is a perceptible rural-urban gradient in stroke prevalence, underlying the dangers of the rapid transition in socioeconomic circumstances seen across the Indian subcontinent. Conclusions-This

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Racial disparities in severity of cerebrovascular events.

Cited by 53 publications

References 30 publications

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

Racial disparities among Native Hawaiians and Pacific Islanders with intracerebral hemorrhage

Current practices in feeding tube placement for US acute ischemic stroke inpatients

Ischemic Stroke in South Asians

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