Abstract 143: Race Differences in 1-year Outcomes after Stroke can be Largely Explained by Race Differences in Physical Functioning before Stroke

Abstract

Background: Several previous investigations, including the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, have demonstrated race and sex differences in long-term outcomes after stroke. However, it is largely unknown whether some of these post-stroke outcome disparities might actually reflect functional differences between the groups that were present before the stroke events. Methods: We examined data from 192 stroke survivors who were enrolled in the Caring for Adults Recovering from the Effects of Stroke (CARES) project. CARES is a REGARDS ancillary study that is examining the long-term effects of stroke on the REGARDS participants who experience a stroke and on their family caregivers. Functional abilities were assessed at baseline and after stroke using structured telephone interviews that included the 12-item Short Form Health Survey (SF-12). Stroke outcomes were measured during in-home examinations conducted approximately 1-year after their adjudicated stroke events. Outcome measures included the NIH Stroke Scale, Barthel index, and the subscales of the Stroke Impact Scale. Age, sex, and education were analyzed as covariates. Results: African Americans had significantly poorer covariate-adjusted 1-year outcomes than Whites on 8 of the 12 outcome measures examined. However, physical functioning before the stroke, as indexed by the Physical Component Summary (PCS) of the SF-12, was significantly lower in African Americans (adjusted Mean = 43.6) than Whites (adjusted Mean = 47.7; p = .005). When these pre-stroke PCS differences were added as additional covariates, many of the race differences in stroke outcome were no longer statistically significant. Conclusions: A substantial portion of the race differences in functional outcomes after stroke appear to reflect extensions of race differences in physical functioning that are present before stroke. In addition to ensuring adequate care after stroke to minority patients, disparities in stroke outcomes might also be further reduced by better risk factor modification and health promotion efforts for African Americans.