Racial differences in mortality among patients with acute ischemic stroke: an observational study.
Racial differences in mortality among patients with acute ischemic stroke: an observational study.
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DOI：
10.7326/0003-4819-154-3-201102010-00004
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发表时间：
2011-02-01
影响因子：
39.2
通讯作者：
Friedman B
中科院分区：
文献类型：
--
作者：
Xian Y;Holloway RG;Noyes K;Shah MN;Friedman B
黑人患者通常被认为中风死亡率更高。然而，最近的几项研究表明黑人中风患者的存活率更高。研究脑卒中死亡率的种族差异，并探讨这些差异的潜在原因。观察性队列研究。2005年1月至2006年12月期间因急性缺血性中风住院的5319名黑人和18340名18岁或以上的白人患者。种族对死亡率的影响，用倾向评分分析检验。次要结果是选定的生命末期治疗、组织型纤溶酶原激活剂的使用、住院费用和住院时间。入院后随访1年死亡率。黑人患者的住院总死亡率低于白人患者（5.0%比7.4%,P <0.001）， 30天（6.1%比11.4%,P <0.001）和1年（16.5%比24.4%,<0.001）全因死亡率也低于白人患者。经倾向评分调整后，黑人种族与较低的住院死亡率（优势比[OR]， 0.77 [95% CI， 0.61至0.98]）和1年内的全因死亡率（OR, 0.86 [CI， 0.77至0.96]）独立相关。校正后的风险比为0.87 （CI, 0.79 ~ 0.96）。在调整了在医院死亡的概率后，黑人中风患者更有可能接受维持生命的干预措施（OR, 1.22 [CI， 1.09至1.38]），但不太可能出院到临终关怀（OR, 0.25 [CI， 0.14至0.46]）。研究使用了缺乏中风严重程度测量的医院行政数据。研究设计排除了因果关系的确定。在急性缺血性卒中患者中，黑人患者的死亡率低于白人患者。这可能是在接受维持生命的干预措施和临终关怀方面存在差异的结果。
Black patients are commonly believed to have higher stroke mortality. However, several recent studies have reported better survival in black patients with stroke. To examine racial differences in stroke mortality and explore potential reasons for these differences. Observational cohort study. 164 hospitals in New York. 5319 black and 18 340 white patients 18 years or older who were hospitalized with acute ischemic stroke between January 2005 and December 2006. Influence of race on mortality, examined by using propensity score analysis. Secondary outcomes were selected aspects of end-of-life treatment, use of tissue plasminogen activator, hospital spending, and length-of-stay. Patients were followed for mortality for 1 year after admission. Overall in-hospital mortality was lower for black than for white patients (5.0% vs. 7.4%; P < 0.001), as was 30-day (6.1% vs. 11.4%; P < 0.001) and 1-year (16.5% vs. 24.4%; <0.001) all-cause mortality. After propensity score adjustment, black race was independently associated with lower in-hospital mortality (odds ratio [OR], 0.77 [95% CI, 0.61 to 0.98]) and all-cause mortality up to 1-year (OR, 0.86 [CI, 0.77 to 0.96]). The adjusted hazard ratio was 0.87 (CI, 0.79 to 0.96). After adjusting for the probability of dying in the hospital, black patients with stroke were more likely to receive life-sustaining interventions (OR, 1.22 [CI, 1.09 to 1.38]) but less likely to be discharged to hospice (OR, 0.25 [CI, 0.14 to 0.46]). Study used hospital administrative data that lacked a stroke severity measure. Study design precluded determination of causality. Among patients with acute ischemic stroke, black patients had lower mortality than white patients. This could be the result of differences in receipt of life-sustaining interventions and end-of-life care.
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影响因子：
8.3
作者：
Johnston, SC;Fung, LH;Brown, AN
通讯作者：
Brown, AN
影响因子：
8.3
作者：
Goldstein, LB;Samsa, GP;Horner, RD
通讯作者：
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影响因子：
3
作者：
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通讯作者：
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影响因子：
2.8
作者：
Holloway, Robert G.;Ladwig, Susan;Quill, Timothy E.
通讯作者：
Quill, Timothy E.
影响因子：
8.3
作者：
Gillum, RF
通讯作者：
Gillum, RF