Neurological, functional, and cognitive stroke outcomes in Mexican Americans.
Neurological, functional, and cognitive stroke outcomes in Mexican Americans.
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DOI：
10.1161/strokeaha.113.003912
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发表时间：
2014-04
期刊：
影响因子：
8.3
通讯作者：
Morgenstern LB
中科院分区：
文献类型：
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作者：
Lisabeth LD;Sánchez BN;Baek J;Skolarus LE;Smith MA;Garcia N;Brown DL;Morgenstern LB
我们的目标是使用基于人群的研究数据来比较墨西哥裔美国人 (MA) 和非西班牙裔白人 (NHW) 的神经、功能和认知中风结果。缺血性中风（2008-2012 年）是通过科珀斯克里斯蒂脑部攻击监测 (BASIC) 项目确定的。数据收集自患者或代理人访谈（在基线和中风后 90 天进行）和医疗记录。使用 Tobit 或线性评估神经系统（美国国立卫生研究院卒中量表 (NIHSS)，范围 0-44，分数越高，分数越差）、功能性（日常生活活动 (ADL)/工具性日常生活活动 (IADL) 分数，范围 1-4，分数越高，分数越差）和认知（改良简易精神状态检查 (3MSE)，范围 0-100，分数越低，分数越差）结果的种族差异 根据人口统计和临床因素进行回归调整。 513、510 和 415 名受试者分别拥有神经、功能和认知结果及协变量的完整数据。中位年龄为 66 岁（IQR：57-78）； 64% 是文学硕士。在 MA 中，NIHSS、ADL/IADL 和 3MSE 评分中位数分别为 3（IQR：1-6）、2.5（IQR：1.6-3.5）和 88（IQR：76-94）。多变量调整后，与 NHW 相比，MA 的 NIHSS 得分较差 48%（95% CI：23%-78%），ADL/IADL 得分较差 0.36 分（95% CI：0.16-0.57），3MSE 得分较差 3.39 分（95% CI：0.35-6.43）。调整混杂因素后，MA 在所有结果上的得分均低于 NHW；生存率的种族差异只能部分解释这种差异。这些发现与 MA 中卒中风险增加相结合表明，在这个不断增长的人群中，卒中的公共卫生负担是巨大的。
Our objective was to compare neurologic, functional, and cognitive stroke outcomes in Mexican Americans (MAs) and non-Hispanic whites (NHWs) using data from a population-based study. Ischemic strokes (2008-2012) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Data were collected from patient or proxy interviews (conducted at baseline and 90 days post-stroke) and medical records. Ethnic differences in neurologic (National Institutes of Health Stroke Scale (NIHSS), range 0-44, higher scores worse), functional (activities of daily living (ADL)/instrumental activities of daily living (IADL) score, range 1-4, higher scores worse), and cognitive (Modified Mini-Mental State Examination (3MSE), range 0-100, lower scores worse) outcomes were assessed with Tobit or linear regression adjusted for demographics and clinical factors. 513, 510, and 415 subjects had complete data for neurologic, functional and cognitive outcomes and covariates, respectively. Median age was 66 (IQR: 57-78); 64% were MA. In MAs, median NIHSS, ADL/IADL and 3MSE score were 3 (IQR: 1-6), 2.5 (IQR: 1.6-3.5) and 88 (IQR: 76-94), respectively. MAs scored 48% worse (95% CI: 23%-78%) on NIHSS, 0.36 points worse (95% CI: 0.16-0.57) on ADL/IADL score, and 3.39 points worse (95% CI: 0.35-6.43) on 3MSE than NHWs after multivariable adjustment. MAs scored worse than NHWs on all outcomes after adjustment for confounding factors; differences were only partially explained by ethnic differences in survival. These findings in combination with the increased stroke risk in MAs suggest that the public health burden of stroke in this growing population is substantial.