Abstract 191: Divergent Short-Term Post-Stroke Outcomes for African Americans Post-Stroke: Lower Mortality, but Greater Disability

Abstract

Background: African Americans (AAs) have more post-stroke disability than non-Hispanic whites (NHWs). Little is known about when this difference emerges. We explored whether this difference exists at the time of post-acute care initiation. Methods: Medicare fee-for-service beneficiaries hospitalized from 2010-2014 with a primary stroke diagnosis (ICD-9-CM 431, 433.x1, 434.x1, 436) were identified. We first estimated adjusted and unadjusted proportions of inpatient mortality/hospice discharge, by race. Of survivors, initial post-stroke function was measured by linking Medicare functional assessment files for Inpatient Rehabilitation (IRF), Skilled Nursing (SNF) and Home Health (HHA). Each assessment file contains measures of initial function based on the Functional Independence Measure (FIM). Cross-walks were applied to the SNF and HHA assessments to generate a FIM-based score for these settings (Pseudo-FIM) using 6 motor FIM items scored 0-7 for a total 6-42 point scale (higher is better). Initial motor FIM/Pseudo-FIM was estimated across all 3 settings and in each setting by race. Adjusted analyses accounted for demographics, ICH, comorbidities, tPA and hospital effects using multi-level regression with random hospital intercepts. Results: 435,371 NHW and 66,707 AA stroke patients were identified. 10.2% of AAs and 14.5% of NHWs (p < 0.001) died or were discharged to hospice, a difference that attenuated slightly after adjustment. Across all settings, AAs had a lower unadjusted motor FIM than NHWs (28.6 vs. 30.5, difference = -1.9, p < 0.001), that attenuated slightly after adjustment (difference -1.7, p < 0.001). Similar unadjusted findings were present across all individual settings for AAs vs. NHWs: IRF (29.8 vs. 31.6, diff = -1.8, p < 0.001), SNF (21.0 vs. 24.7, diff=-3.7, p < 0.001), HHA (33.8 vs. 36.0, diff = -2.2, p < 0.001). Trends were minimally altered by adjustment. Conclusions: Mortality and disability immediately after stroke hospitalization diverge by race. Compared to NHWs, AAs have lower early mortality, bit worse motor function across rehab settings. These data suggest that racial differences in patient treatment preferences surrounding mortality-disability trade-offs may exist.