Abstract WP90: Black Americans Have Worse Functional And Cognitive Outcomes Than White Americans After Stroke

Abstract

Introduction: We studied racial differences in post-stroke outcomes using a prospective, population-based cohort of stroke survivors as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project. Methods: Neurologic (NIHSS, range of 0-42, higher scores are worse), functional (ADLs/IADLs, range 1-4, higher scores are worse), and cognitive (3MSE, range 0-100, higher scores are better) outcomes were measured 90 days after stroke. Cox proportional hazards and negative binomial linear regression models were used to examine the associations between race and 90-day all-cause mortality and NIHSS, respectively, whereas linear regression was used for ADLs/IADLs and 3MSE scores. Covariates included demographics, initial NIHSS, comorbidities, prior stroke history, tPA, pre-stroke disability, and pre-stroke cognition. The mortality model also adjusted for DNR status. Results: At 90 days post-stroke, Black Americans (BAs) (n=130) had a median (IQR) NIHSS of 2 (1,6) compared to NIHSS of 1 (0,3) in non-Hispanic white Americans (NHWs) (n=868). BAs had a median (IQR) ADL/IADL score of 2.4 (1.5, 3.4) compared to 2 (1.3, 3.0) in NHWs. BAs scored a median of 85.0 (75.0, 92.5) on the 3MSE compared to NHWs’ score of 92.0 (83.0, 96.0). Death occurred in 23 (11%) of BAs and 268 (19%) of NHWs within 90 days. After adjustment for covariates, functional outcomes at 90 days were worse in BAs compared to NHWs, with 14% (95% CI=4.9, 23) greater limitations in ADLs/IADLs and 47.9% (95% CI=16.3, 88.1) greater severity of stroke symptoms. Cognition at 90 days was 7% (95% CI=2.7, 11.3) lower in BAs compared to NHWs. BAs had a 25.2% lower (95% CI=-19.9, 53.3) hazard rate of mortality than NHWs (Figure). Conclusions: In this prospective, population-based community sample, BAs had worse functional and cognitive outcomes at 90 days compared to NHWs. Future research should investigate the cause of these racial disparities.