Abstract
Background: Few studies report 10-year mortality outcomes after stroke in the US by race. We assessed long-term survivorship by race among elderly ischemic stroke patients. Methods: We identified fee-for-service Medicare beneficiaries aged ≥65 years discharged alive from US acute-care hospitals with a principal diagnosis of ischemic stroke from 2005 to 2007. Patients were followed through 2016 to calculate 10-year all-cause mortality, censoring for change in Medicare enrollment. Inverse probability weighting (IPW) was used to assess race differences in mortality. We used logistic regression to calculate the probability of a patient being Black as a function of age, Medicaid eligibility, comorbidities, in-hospital complications, discharge disposition, length of stay, and Medicare payment. We then fit a Cox regression model for the relationship between race and 10-year mortality that adjusted for sex and the inverse probability of being Black. Results: There were 744,044 patients discharged alive with stroke (mean age 78.7y, 54.7% women, 85.6% White, 9.9% Black, and 4.5% other race). Black patients tended to be younger and were more often women. There were race differences in comorbidities, with renal failure, dementia, and diabetes more common in Blacks; atherosclerosis and COPD were more common in Whites. The 10-year mortality rate was 75.3% (95% CI 75.2–75.4%) for the overall population, with Blacks having the highest mortality (76.4%, 76.1–76.7%), followed by Whites (75.4%, 75.3–75.5%) and those of other race (70.3%, 69.8–70.8%; Figure). In the IPW analysis, the risk of death within 10 years of stroke was higher for Blacks (RR 1.04, 95% CI 1.03–1.04) but lower for other races (RR 0.92, 95% CI 0.90–0.93) when compared with Whites. Conclusions: More than 75% of stroke patients died within 10 years. The 10-year stroke mortality risk was higher for Black stroke patients even after accounting for sociodemographic and index hospitalization factors.
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