Ethnic disparities in health-related quality of life and cognitive function after stroke in the Netherlands

BACKGROUND/OBJECTIVE: European data regarding ethnic disparities in health-related quality of life (HRQOL) post- stroke is scarce and none used the Patient-Reported Outcomes Measurement Information System (PROMIS). This study explores whether ethnicity is related to HRQOL using PROMIS and cognitive function after stroke in the Netherlands. METHODS: Patients hospitalized with a first-ever stroke were included. Outcome assessments included the PROMIS Profile, the EuroQoL-5D-3 L for HRQOL and the PROMIS Cognitive Function for cognitive functioning. Measurements were done at admission, after 3 and 12 months (EQ-5D and EQ-5D-VAS only at 12 months). Ethnicity (migration background yes/no), demographics and stroke characteristics were collected. Outcomes were compared between patients with and without a migration background by a multivariate linear mixed-effects model, adjusted for age, sex, education level, severity of stroke and other relevant variables at baseline were also included (smoking before admission, acute intervention in case of an ischemic stroke and length of hospital stay). RESULTS: 262 patients were included of which 74 (28.2%) had a migration background. This group had worse scores compared to patients without a migration background, with a significant difference at admission for the physical function (estimate = 3.30, SE = 1.25, p = 0.01), at three months for anxiety (estimate=-2.95, SE = 1.48, p = 0.05) and twelve months for sleep disturbance (estimate=-5.43, SE = 1.61, p < 0.01). The EQ-5D index and EQ-5D VAS at twelve months follow-up was also significantly lower in this group compared to patients without a migration background (respectively adjusted B -0.09 (95% CI -0.17; -0.01)) and adjusted B -7.27 (95% CI (-13.99; -0.56)). CONCLUSION: Up to twelve months, stroke patients with a migration background had worse scores and a different trajectory regarding several domains of HRQOL compared to patients without a migration background.