Journal article
Differences in Initial Stroke Severity Between Mexican Americans and Non-Hispanic Whites Vary by Age: The Brain Attack Surveillance in Corpus Christi (BASIC) Project
Cerebrovascular diseases (Basel, Switzerland), v 38(5), pp 362-369
01 Dec 2014
PMCID: PMC4286523
PMID: 25427748
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: A wide variety of racial and ethnic disparities in stroke epidemiology and treatment have been reported. Race-ethnic differences in initial stroke severity may be one important determinant of differences in the outcome after stroke. The overall goal of this study was to move beyond ethnic comparisons in the mean or median severity, and instead investigate ethnic differences in the entire distribution of initial stroke severity. Additionally, we investigated whether age modifies the relationship between ethnicity and initial stroke severity as this may be an important determinant of racial differences in the outcome after stroke. Methods: Ischemic stroke cases were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project. National Institutes of Health Stroke Scale (NIHSS) was determined from the medical record or abstracted from the chart. Ethnicity was reported as Mexican American (MA) or non-Hispanic white (NHW). Quantile regression was used to model the distribution of NIHSS score by age category (45-59, 60-74, 75+) to test whether ethnic differences exist over different quantiles of NIHSS (5 percentile increments). Crude models examined the interaction between age category and ethnicity; models were then adjusted for history of stroke/transient ischemic attack, hypertension, atrial fibrillation, coronary artery disease, and diabetes. Results were adjusted for multiple comparisons. Results: There were 4,366 ischemic strokes, with median age 72 (IQR: 61-81), 55% MA, and median NIHSS of 4 (IQR: 2-8). MAs were younger, more likely to have a history of hypertension and diabetes, but less likely to have atrial fibrillation compared to NHWs. In the crude model, the ethnicity-age interaction was not statistically significant. After adjustment, the ethnicity-age interaction became significant at the 85th and 95th percentiles of NIHSS distribution. MAs in the younger age category (45-59) were significantly less severe by 3 and 6 points on the initial NIHSS than NHWs, at the 85th and 95th percentiles, respectively. However, in the older age category (75+), there was a reversal of this pattern; MAs had more severe strokes than NHWs by about 2 points, though not reaching statistical significance. Conclusions: There was no overall ethnic difference in stroke severity by age in our crude model. However, several potentially important ethnic differences among individuals with the most severe strokes were seen in younger and older stroke patients that were not explained by traditional risk factors. Age should be considered in future studies when looking at the complex distributional relationship between ethnicity and stroke severity. (C) 2014 S. Karger AG, Basel
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Details
- Title
- Differences in Initial Stroke Severity Between Mexican Americans and Non-Hispanic Whites Vary by Age: The Brain Attack Surveillance in Corpus Christi (BASIC) Project
- Creators
- Jeffrey J. Wing - University of Michigan–Ann ArborJonggyu Baek - University of Michigan–Ann ArborBrisa N. Sanchez - Biostatistical ConsultingLynda D. Lisabeth - Samuel and Jean Frankel Cardiovascular CenterMelinda A. Smith - Univ Michigan, Dept Neurol, Stroke Program, Ann Arbor, MI 48109 USALewis B. Morgenstern - NeurologyDarin B. Zahuranec - Samuel and Jean Frankel Cardiovascular Center
- Publication Details
- Cerebrovascular diseases (Basel, Switzerland), v 38(5), pp 362-369
- Publisher
- Karger
- Number of pages
- 8
- Grant note
- R01NS038916 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) R0138916 / National Institutes of Health/National Institute of Neurological Disorders and Stroke; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) K23AG038731 / National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000348046700007
- Scopus ID
- 2-s2.0-84912077403
- Other Identifier
- 991020099205904721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Clinical Neurology
- Peripheral Vascular Disease