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Stroke mortality and race: does access to care influence outcomes?
Masoor Kamalesh1, Jianzhao Shen, William M Tierney
1Roudebush VA Medical Center and Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA. Masoor.kamalesh@med.va.gov
The American Journal of the Medical Sciences
|June 16, 2007
Summary
African-Americans (AA) had lower mortality rates after ischemic stroke discharge in VA hospitals compared to white patients. This finding contrasts with non-VA studies and suggests VA care may improve stroke outcomes for AA.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- Stroke is a leading cause of death in the U.S.
- Racial disparities in stroke mortality exist.
- Previous studies reported higher stroke mortality in African-Americans (AA) in non-VA settings.
Purpose of the Study:
- To investigate racial differences in post-discharge mortality after ischemic stroke.
- To determine if Veterans Health Administration (VHA) care access influences stroke mortality rates in AA.
- To test the hypothesis that VA care mitigates excess stroke mortality in AA.
Main Methods:
- Analysis of VHA administrative data for ischemic stroke patients discharged between 1990-1997.
- Inclusion of demographic, clinical, and mortality data.
- Calculation of Charlson comorbidity index and 1-year survival analysis.
Main Results:
- Study included 55,094 VHA stroke patients (63% white, 21% AA).
- Charlson comorbidity index was similar between racial groups.
- One-year mortality was higher for white patients (HR 1.06; 95% CI 1.02-1.10), with survival rates of 0.86 for whites vs. 0.87 for AA.
Conclusions:
- AA patients experienced marginally lower mortality rates post-discharge from VA hospitals after ischemic stroke.
- This outcome contrasts with findings from non-VA hospitals.
- Access to VHA care may play a role in reducing stroke-related deaths in AA.
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