Where to Focus Efforts to Reduce the Black–White Disparity in Stroke Mortality

Abstract

Background and Purpose-At age 45 years, blacks have a stroke mortality ≈3× greater than their white counterparts, with a declining disparity at older ages. We assess whether this black-white disparity in stroke mortality is attributable to a black-white disparity in stroke incidence versus a disparity in case fatality. Methods-We first assess if black-white differences in stroke mortality within 29 681 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort reflect national black-white differences in stroke mortality and then assess the degree to which black-white differences in stroke incidence or 30-day case fatality after stroke contribute to the disparities in stroke mortality. Results-The pattern of stroke mortality within the study mirrors the national pattern, with the black-to-white hazard ratio of ≈4.0 at age 45 years decreasing to ≈1.0 at age 85 years. The pattern of black-to-white disparities in stroke incidence shows a similar pattern but no evidence of a corresponding disparity in stroke case fatality. Conclusions-These findings show that the black-white differences in stroke mortality are largely driven by differences in stroke incidence, with case fatality playing at most a minor role. Therefore, to reduce the black-white disparity in stroke mortality, interventions need to focus on prevention of stroke in blacks.

Foreign-born blacks no different from whites for odds of stroke

“…Furthermore, this study is based on stroke prevalence, which may be the consequence of case fatality. However, this seems unlikely as findings on disease-specific mortality, a product of incidence rate and case fatality, show that black–white differences in stroke mortality are largely driven by racial disparities in stroke incidence and not case fatality, thus supporting our hypothesis that higher stroke prevalence is likely due to a higher stroke incidence among blacks 31. Second, our measure of stroke risk was limited to a binary selection that did not include the different types of stroke — ischaemic, transient ischaemic and haemorrhagic — and the nature of self-report data may lead to misclassification.…”

Stroke Risk Factors, Genetics, and Prevention

“…57-60 The racial disparity in stroke mortality is being driven by the racial disparities in stroke incidence, highlighting the importance of stroke prevention interventions aimed at minority groups. 61 Interestingly, the association seen between black race and stroke, while strong for incident stroke, does not remain for recurrent stroke. 62 This could be due to stroke risk factors being addressed upon discharge from the primary stroke event.…”

“…Further, blacks are more likely to suffer from increased blood pressure variability and are less likely to be adequately treated, all poor prognostic factors in the development of blood pressure-related morbidity. 61 Beta blockers, thiazide diuretics, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers are the most widely studied agents, and while there are are some class differences, the majority of benefit is conferred by the level of blood pressure control rather than the class of medication used. 247 …”

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

“…50,68,69 For example, 47% of blacks were estimated to have hypertension in 2015 compared with 40% of white non-Hispanics, consequently increasing their risk for stroke and heart failure. 1,[70][71][72] Studies of traumatic spinal cord injury and other chronic conditions suggest that blacks were more likely to receive informal care from other family members, friends, church support, and others, whereas whites were more likely to receive informal or family care from spouses. 73 Level of income was most directly related to the use of paid versus unpaid care.…”