Multiple Chronic Conditions Explain Ethnic Differences in Functional Outcome Among Patients With Ischemic Stroke

Area of Science:

• Neurology
• Public Health
• Health Disparities

Background:

• Mexican Americans (MAs) face poorer stroke outcomes and distinct multiple chronic conditions (MCC) profiles compared to non-Hispanic White individuals.
• MCC significantly impacts stroke treatment, complications, and poststroke care, ultimately affecting functional outcomes (FO).

Purpose of the Study:

• To evaluate the extent to which MCC contributes to the ethnic disparities in FO at 90 days post-stroke between MAs and non-Hispanic White people.

Main Methods:

• A prospective cohort study of ischemic stroke patients (2008-2016) in Nueces County, Texas.
• MCC burden assessed using a stroke-specific index; FO measured by activities of daily living (ADLs) at 90 days.
• Tobit regression used to analyze MCC's contribution to ethnic differences in FO, with examination of effect modification by ethnicity.

Main Results:

• MAs exhibited a higher age-adjusted MCC burden than non-Hispanic White individuals.
• Higher MCC scores correlated with worse FO at 90 days (0.70 points higher FO score for high vs. low MCC).
• MCC accounted for 19% of the ethnic difference in FO; effect modification by ethnicity was not significant.

Conclusions:

• Elevated age-adjusted MCC burden in MAs partially explains ethnic disparities in poststroke FO.
• Targeting MCC prevention and treatment may mitigate functional impairment and reduce ethnic disparities in stroke outcomes.