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Survival analysis is a statistical method used to study time-to-event data, where the "event" might represent outcomes like death, disease relapse, system failure, or recovery. A unique feature of survival data is censoring, which occurs when the event of interest has not been observed for some individuals during the study period. This requires specialized techniques to handle incomplete data effectively.
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Temporal Trends and Racial Disparities in Long-Term Survival After Stroke.

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Five-year stroke mortality improved for ischemic strokes but not for hemorrhages. Black individuals, especially men with good baseline function, face higher mortality risks after ischemic stroke, a disparity persisting over time.

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Area of Science:

  • Neurology
  • Public Health
  • Epidemiology

Background:

  • Few studies have investigated long-term stroke outcome trends and disparities in the US population.
  • This study examines 5-year mortality trends and racial disparities following acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH).

Purpose of the Study:

  • To analyze trends and racial disparities in 5-year post-stroke mortality using a population-based cohort.
  • To identify specific demographic or clinical factors contributing to observed disparities.

Main Methods:

  • Population-based study in the Greater Cincinnati/Northern Kentucky region from 1993-2015.
  • Ascertainment of AIS and ICH cases (≥20 years old) using ICD codes and physician adjudication.
  • Analysis of 5-year mortality using the National Death Index, with logistic regression for trends and disparities, adjusting for age, sex, functional status, and comorbidities.

Main Results:

  • Overall 5-year mortality for AIS decreased from 53% to 48.3% (p=0.009), exceeding general population improvements.
  • Black individuals had higher AIS mortality (OR 1.23), a disparity persisting across study years.
  • No significant change in 5-year mortality for ICH was observed (64.4% to 69.2%, p=0.32).
  • Among males with good premorbid function, Black race remained a significant predictor of higher AIS mortality (OR 1.4).

Conclusions:

  • Long-term survival has improved following acute ischemic stroke but not intracerebral hemorrhage.
  • Racial disparities in mortality after AIS persist, particularly affecting Black men with good premorbid functional status.
  • These disparities in stroke outcomes require targeted interventions to ensure equitable care and improve long-term survival for all populations.