Disparity in stroke recurrence improving among Mexican Americans
Click Here to Manage Email Alerts
From 2000 to 2013, researchers reported significant improvements in stroke disparity among Mexican Americans compared with non-Hispanic white adults in the U.S.
“By the end of the study period in 2013, the disparity between the two groups had vanished,” Cemal B. Sozener, MD, assistant professor of emergency medicine at the University of Michigan Medical School, told Healio. “This is the first time in the 19 years of the BASIC project that we have uncovered an improvement in any major marker of ethnic stroke disparities. Cardiac clinicians can further decrease stroke recurrence utilizing evidence-based secondary stroke prevention guidelines when indicated.”
For this analysis of the Brain Attack Surveillance in Corpus Christi (BASIC) project, published in Stroke, researchers assessed ethnic-specific 14-year stroke recurrence trends among Mexican American (n = 1,989; mean age, 67 years; 50% women) and non-Hispanic white patients (n = 1,544; mean age, 75 years; 51% women).
In 2000, researchers found that the adjusted cumulative incidence of 1-year stroke recurrence among Mexican American patients was 9.26% (95% CI, 6.9-12.43) and fell to 3.42% in 2013 (95% CI, 2.25-5.21).
Among non-Hispanic white patients, the rate of 1-year stroke recurrence was 5.67% in 2000 (95% CI, 3.74-8.62) and dropped to 3.59% in 2013 (95% CI, 2.27-5.68).
According to the researchers, these findings demonstrated such a reduction in ethnic disparity that any differences were no longer visible by 2013 (risk difference, 0.17%; 95% CI, 1.96 to 1.5).
“The reasons for this welcome recurrence disparity reduction are uncertain. Possibilities include greater improvements in risk factor control over time in Mexican Americana compared with non-Hispanic whites,” the researchers wrote. “While we were able to adjust for the presence of key stroke risk factors like hypertension, we were unable to account for hypertension severity, control and medication adherence, which might contribute to the observed ethnic-specific trends.”
Researchers also reported that the lower recurrence rate among non-Hispanic white patients may be swayed by elevated mortality compared with Mexican American patients (the 1-year mortality risk difference in 2000, 3.55%; 95% CI, 6.8 to 0.09).
Moreover, the cause-specific HR only showed significance at the level of P = .1 (cause-specific HR = 1.61; P = .075). Investigators hypothesize that these findings may point to actual ethnicity driving disparity rather than an indirect effect of competing event of mortality.
“Recurrent stroke leads to worse functional outcomes as well as higher risk of mortality,” Sozener said in an interview. “Monitoring trends in ethnic minority communities is crucial for public health planning, and through health system interventions, can lead to reductions in health disparities. While we are pleased to see this single marker of stroke disparities improved, we believe that further work needs to be done to help reduce health disparities among Hispanic/Latinx and African American populations.”
Collapse
Read more about
Click Here to Manage Email Alerts