Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality
Racial differences in recurrent ischemic stroke risk and recurrent stroke case fatality
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DOI：
10.1212/wnl.0000000000006467
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发表时间：
2018-11-06
期刊：
影响因子：
9.9
通讯作者：
Howard, Virginia
中科院分区：
文献类型：
--
作者：
Albright, Karen C.;Huang, Lei;Howard, Virginia
Objectives确定黑人和白人在1年内复发性卒中和30天内复发性卒中后死亡率的差异，在老年人中，我们进行了一项回顾性队列研究，使用了5%的医疗保险受益人的随机样本，这些受益人在1999年至2013年期间因缺血性卒中住院治疗，并获得了按服务收费的健康保险。复发性缺血性中风的风险比和30天的病死率比较黑人白人的风险比计算调整人口统计学，风险因素，并竞争死亡的风险，当appropriate.ResultsAmong 128，789医疗保险受益人缺血性中风（平均年龄80岁[SD 8年]，60.4%的男性），11.1%是黑人。白人和黑人每1,000人-年的复发性缺血性卒中发生率分别为108（95%置信区间[CI]，106-111）和154（95% CI 147-162）。与白人相比，黑人卒中复发的多变量校正风险比为1.36（95%CI 1.29-1.44）。黑人和白人复发性卒中后的病死率分别为21%（95% CI 21%-22%）和16%（95% CI 15%-18%）。多变量调整后的相对危险度为30天内的黑人与白人相比，复发性中风的死亡率为0.82（95%CI 0.73-0.93）conclusionThe风险中风复发的老年人住院缺血性中风的美国人是较高的黑人相比，白人，而30天内的病例死亡率复发性中风后仍然较低的黑人。
ObjectiveTo determine black-white differences in 1-year recurrent stroke and 30-day case fatality after a recurrent stroke in older US adults.MethodsWe conducted a retrospective cohort study using a 5% random sample of Medicare beneficiaries with fee-for-service health insurance coverage who were hospitalized for ischemic stroke between 1999 and 2013. Hazard ratios for recurrent ischemic stroke and risk ratios for 30-day case fatality comparing blacks to whites were calculated with adjustment for demographics, risk factors, and competing risk of death when appropriate.ResultsAmong 128,789 Medicare beneficiaries having an ischemic stroke (mean age 80 years [SD 8 years], 60.4% male), 11.1% were black. The incidence rate of recurrent ischemic stroke per 1,000 person-years for whites and blacks was 108 (95% confidence interval [CI], 106-111) and 154 (95% CI 147-162), respectively. The multivariable-adjusted hazard ratio for recurrent stroke among blacks compared with whites was 1.36 (95% CI 1.29-1.44). The case fatality after recurrent stroke for blacks and whites was 21% (95% CI 21%-22%) and 16% (95% CI 15%-18%), respectively. The multivariable-adjusted relative risk for mortality within 30 days of a recurrent stroke among blacks compared with whites was 0.82 (95% CI 0.73-0.93).ConclusionThe risk of stroke recurrence among older Americans hospitalized for ischemic stroke is higher for blacks compared to whites, while 30-day case fatality after recurrent stroke remains lower for blacks.