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Racial differences in cerebrovascular disease hospitalizations
A L Klatsky1, M A Armstrong, G D Friedman
1Department of Medicine, Kaiser Permanente Medical Care Program, Oakland, Calif. 94611-5693.
Insights
Blacks face higher hospitalization risks for certain cerebrovascular diseases like hemorrhagic stroke and cerebral thrombosis compared to whites. However, they have a lower risk for extracranial occlusive disease, indicating complex racial disparities in stroke incidence.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Cerebrovascular disease (stroke) is a leading cause of morbidity and mortality.
- Understanding racial disparities in stroke incidence and type is crucial for targeted prevention and treatment.
Purpose of the Study:
- To investigate the relationship between race and the incidence of hospitalization for different types of cerebrovascular disease.
- To identify specific cerebrovascular disease subtypes where racial differences in hospitalization risk are most pronounced.
Main Methods:
- Analysis of hospitalization data from 74,096 white and 33,041 black individuals in a prepaid health care program.
- Statistical adjustments for multiple confounding factors including age, sex, BMI, lifestyle factors, and blood pressure.
- Calculation of relative risks and confidence intervals to compare hospitalization rates between racial groups for various cerebrovascular disease types.
Main Results:
- Black individuals exhibited significantly higher hospitalization risks for hemorrhagic cerebrovascular disease (RR=2.4), cerebral thrombosis (RR=1.9), and nonspecific cerebrovascular disease (RR=1.6) compared to white individuals.
- Conversely, black individuals had a lower hospitalization risk for extracranial occlusive disease (RR=0.4).
- While blood pressure influenced all cerebrovascular disease types similarly across races, other atherosclerosis risk factors showed disparate relationships, and educational attainment did not explain the disparity in extracranial occlusive disease.
Conclusions:
- Significant, unexplained racial differences exist in the incidence and type of cerebrovascular disease hospitalization.
- These disparities highlight the need for further research into the pathogenesis of cerebrovascular disease and have important clinical implications for risk assessment and management in diverse populations.
Abstract:
We studied the relationship of race to incidence of hospitalization for cerebrovascular disease among 74,096 white and 33,041 black persons who took health examinations in a prepaid health care program. Analyses were controlled for age, sex, body mass index, coffee use, smoking, alcohol use, systolic blood pressure, and baseline disease. Blacks were at higher hospitalization risk than whites for hemorrhagic cerebrovascular disease (relative risk = 2.4, 95% confidence interval = 1.3-5.8), cerebral thrombosis (relative risk = 1.9, 95% confidence interval = 1.2-2.9), and nonspecific cerebrovascular disease (relative risk = 1.6, 95% confidence interval = 1.2-2.2) but at lower hospitalization risk for extracranial occlusive disease (relative risk = 0.4, 95% confidence interval = 0.2-0.7). Blood pressure had a similar relation to all types of cerebrovascular disease in both races, but there were disparities in the relations of other atherosclerosis risk factors to different types of cerebrovascular disease. Educational attainment had little relation to hospitalization for extracranial occlusive disease, a finding that reduces the likelihood that selection bias explains the racial disparity. These data show unexplained racial differences in the type and location of cerebrovascular disease. The differences are important in understanding the pathogenesis of cerebrovascular disease and have practical clinical implications.