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Recent racial/ethnic disparities in stroke hospitalizations and outcomes for young adults in Florida, 2001-2006.
Neuroepidemiology. 2009; 32(4):302-11.N

Abstract

BACKGROUND

Black-white disparities in stroke mortality are well documented, but few recent studies have examined racial/ethnic disparities in stroke hospitalizations among young adults. We analyzed recent (2001-2006) trends in stroke hospitalizations and hospital case-fatality for black, Hispanic, and white adults aged 25-49 years in Florida.

METHODS

Hospitalization rates were calculated using population estimates from the census, and hospital discharges with a primary diagnosis of stroke (ICD-9-CM 430, 431, 434, 436) (n = 16,317). Multivariate logistic regression modeling was used to examine racial/ethnic disparities in stroke mortality prior to discharge, after adjustment for patient sociodemographics, stroke subtype, risk factors, and comorbidities.

RESULTS

Age-adjusted stroke hospitalization rates for blacks were over 3 times higher than rates for whites, while rates for Hispanics were slightly higher than rates for whites. Hemorrhagic strokes were proportionally greater among Hispanics compared with blacks and whites (p < 0.0001). Blacks were most likely to have diagnosed hypertension (62.3%), morbid obesity (10.9%) or drug abuse (13.6%). Whites were most likely to have diagnosed hyperlipidemia (21.0%), alcohol abuse (9.5%), and to be smokers (30.6%). The in-hospital fatality rate for all strokes was highest among blacks (10.0%) compared with whites (9.0%) and Hispanics (8.2%). After adjustment for age, gender, insurance status, and all diagnosed risk factors and comorbidities, the black excess was no longer observed [odds ratio (OR) 1.01, 95% confidence interval (CI) 0.88-1.15, p = 0.93]. However, the Hispanic advantage in case-fatality was strengthened (OR 0.66, 95% CI 0.55-0.79, p < 0.0001). Separate case-fatality analyses for ischemic versus hemorrhagic strokes yielded similar results.

CONCLUSIONS

Our study found a strong and persistent black-white disparity in stroke hospitalization rates for young adults. In contrast, rates were similar for Hispanics and whites. Multivariate adjustment explained the 15% excess case-fatality for blacks; the short-term mortality advantage among Hispanics was strengthened after adjustment.

Authors+Show Affiliations

Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Fla. 33612, USA. ebarnett@health.usf.eduNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19287184

Citation

Pathak, Elizabeth Barnett, and Michael A. Sloan. "Recent Racial/ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001-2006." Neuroepidemiology, vol. 32, no. 4, 2009, pp. 302-11.
Pathak EB, Sloan MA. Recent racial/ethnic disparities in stroke hospitalizations and outcomes for young adults in Florida, 2001-2006. Neuroepidemiology. 2009;32(4):302-11.
Pathak, E. B., & Sloan, M. A. (2009). Recent racial/ethnic disparities in stroke hospitalizations and outcomes for young adults in Florida, 2001-2006. Neuroepidemiology, 32(4), 302-11. https://doi.org/10.1159/000208795
Pathak EB, Sloan MA. Recent Racial/ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001-2006. Neuroepidemiology. 2009;32(4):302-11. PubMed PMID: 19287184.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recent racial/ethnic disparities in stroke hospitalizations and outcomes for young adults in Florida, 2001-2006. AU - Pathak,Elizabeth Barnett, AU - Sloan,Michael A, Y1 - 2009/03/13/ PY - 2008/08/20/received PY - 2008/10/16/accepted PY - 2009/3/17/entrez PY - 2009/3/17/pubmed PY - 2009/7/1/medline SP - 302 EP - 11 JF - Neuroepidemiology JO - Neuroepidemiology VL - 32 IS - 4 N2 - BACKGROUND: Black-white disparities in stroke mortality are well documented, but few recent studies have examined racial/ethnic disparities in stroke hospitalizations among young adults. We analyzed recent (2001-2006) trends in stroke hospitalizations and hospital case-fatality for black, Hispanic, and white adults aged 25-49 years in Florida. METHODS: Hospitalization rates were calculated using population estimates from the census, and hospital discharges with a primary diagnosis of stroke (ICD-9-CM 430, 431, 434, 436) (n = 16,317). Multivariate logistic regression modeling was used to examine racial/ethnic disparities in stroke mortality prior to discharge, after adjustment for patient sociodemographics, stroke subtype, risk factors, and comorbidities. RESULTS: Age-adjusted stroke hospitalization rates for blacks were over 3 times higher than rates for whites, while rates for Hispanics were slightly higher than rates for whites. Hemorrhagic strokes were proportionally greater among Hispanics compared with blacks and whites (p < 0.0001). Blacks were most likely to have diagnosed hypertension (62.3%), morbid obesity (10.9%) or drug abuse (13.6%). Whites were most likely to have diagnosed hyperlipidemia (21.0%), alcohol abuse (9.5%), and to be smokers (30.6%). The in-hospital fatality rate for all strokes was highest among blacks (10.0%) compared with whites (9.0%) and Hispanics (8.2%). After adjustment for age, gender, insurance status, and all diagnosed risk factors and comorbidities, the black excess was no longer observed [odds ratio (OR) 1.01, 95% confidence interval (CI) 0.88-1.15, p = 0.93]. However, the Hispanic advantage in case-fatality was strengthened (OR 0.66, 95% CI 0.55-0.79, p < 0.0001). Separate case-fatality analyses for ischemic versus hemorrhagic strokes yielded similar results. CONCLUSIONS: Our study found a strong and persistent black-white disparity in stroke hospitalization rates for young adults. In contrast, rates were similar for Hispanics and whites. Multivariate adjustment explained the 15% excess case-fatality for blacks; the short-term mortality advantage among Hispanics was strengthened after adjustment. SN - 1423-0208 UR - https://www.unboundmedicine.com/medline/citation/19287184/Recent_racial/ethnic_disparities_in_stroke_hospitalizations_and_outcomes_for_young_adults_in_Florida_2001_2006_ L2 - https://www.karger.com?DOI=10.1159/000208795 DB - PRIME DP - Unbound Medicine ER -