MINNEAPOLIS – Black and Hispanic people are more likely to die in the first month after certain types of stroke than white people, according to a study published in the June 1, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology.
“We’ve known that there are disparities in death from stroke among racial and ethnic groups in the U.S. due to higher stroke rates, higher burden of risk factors for stroke, socioeconomic inequality and structural racism, but we have needed more information breaking these differences down by type of stroke,” said study author Hugo J. Aparicio, MD, MPH, of Boston University School of Medicine in Massachusetts and a member of the American Academy of Neurology. “These results will help us to better understand the nature of this health inequity.”
For the study, researchers reviewed health records of 37,790 people who had strokes and were hospitalized in the Veterans Health Administration over a 10-year period. They then looked at which participants died during the following month and for more than a year after the stroke.
A total of 89% of the strokes were ischemic, which are strokes caused by a blood clot. Another 9% were intracerebral hemorrhage strokes and 2% were subarachnoid hemorrhage strokes, both of which are caused by bleeding in the brain. Men made up 98% of the participants.
When researchers adjusted for factors that could affect risk of death after stroke, such as smoking, diabetes, and heart disease, Hispanic people who had subarachnoid hemorrhage strokes had a 10.3% higher risk of death during the month after the stroke than white people with the same type of stroke, with Hispanic people having a 30% increased risk and white people having a 20% increased risk. Black people who had intracerebral hemorrhage strokes had a 3% higher risk of death during the month after the stroke than white people with that type of stroke, with Black people having a 30% increased risk and white people having a 27% increased risk.
“Differences in mortality by race or ethnicity varied substantially when considering specific types of stroke, especially the different types of hemorrhagic stroke,” said Aparicio. “If all types of stroke are considered together as one disease, it may mask underlying racial or ethnic disparities, since risk factors, such as age or blood pressure, and underlying social determinants of health, such as access to health care or structural racism, may vary differently between these outcomes. Given these differences in stroke mortality by race and ethnicity, it is clear that more research is also needed in Native American, Alaska Native, Native Hawaiian and Asian American groups.”
Aparicio noted that future studies should look into group differences in vascular risk factors and management of risk factors, stroke severity, and the effects of racism that may contribute to this inequity in surviving after a stroke.
A limitation of the study was that nearly all of the participants were male veterans, so the results may not apply to women and the general population. In addition, the researchers were not able to adjust for the severity of the strokes.
The study was supported by the Department of Veterans Affairs.
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The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.