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Where to Focus Efforts to Reduce the Black-White Disparity in Stroke Mortality: Incidence Versus Case Fatality?
Journal article   Open access   Peer reviewed

Where to Focus Efforts to Reduce the Black-White Disparity in Stroke Mortality: Incidence Versus Case Fatality?

George Howard, Claudia S Moy, Virginia J Howard, Leslie A McClure, Dawn O Kleindorfer, Brett M Kissela, Suzanne E Judd, Fredrick W Unverzagt, Elsayed Z Soliman, Monika M Safford, …
Stroke (1970), v 47(7), pp 1893-1898
Jul 2016
PMID: 27256672
url
https://doi.org/10.1161/strokeaha.115.012631View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze) Open
url
https://doi.org/10.1161/STROKEAHA.115.012631View
Published, Version of Record (VoR) Open

Abstract

African Continental Ancestry Group - statistics & numerical data Age Factors Age of Onset Aged Aged, 80 and over Anthropometry Comorbidity European Continental Ancestry Group - statistics & numerical data Female Follow-Up Studies Health Status Disparities Humans Incidence Male Middle Aged Mortality - ethnology Odds Ratio Risk Factors Stroke - epidemiology Stroke - ethnology Stroke - prevention & control United States - epidemiology
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. 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. 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. 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.

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Collaboration types
Domestic collaboration
Web of Science research areas
Clinical Neurology
Peripheral Vascular Disease
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