Asian American Patients Research Articles

The Clinical Presentation of Chronic Hepatitis B Virus Infection in Asian Americans

The clinical course of chronic hepatitis B virus (HBV) infection varies with ethnicity. Little is known about the clinical presentation of chronic HBV infection in Asian Americans. To define the clinical presentation of chronic HBV infection in Asian Americans. This is a retrospective study that used systematic chart review and statistical analysis to investigate 213 Asian-American patients with chronic HBV infection who presented to a university medical center. This cohort included 55.8% male patients, 97.9% were born outside the US, and 52.3% reported a family history of HBV infection. Of the 56 patients with liver biopsy, 34.0% had stage 3 to 4 fibrosis. In patients with available data, 21.5% were hepatitis B e antigen positive [HBeAg (+)] and 31.1% had HBV DNA levels >1 x 10(6) copies/mL. Patients with HBeAg (+) HBV infection were diagnosed at a younger age (P=0.002) and with higher alanine aminotransferase (P=0.001) and HBV DNA (P=0.001) levels. Although only 3.3% presented with obesity (ie, body mass index >or=30 kg/m2), 43.4% had evidence of hepatic steatosis. Presentation of hepatocellular carcinoma was associated with an older age at diagnosis (P<0.001), male sex (P<0.001), tobacco use (P<0.001), a greater degree of fibrosis on liver biopsy (P=0.01), and higher alanine aminotransferase, aspartate aminotransferase (P<0.001), and a fetoprotein (P<0.001) levels. Chronic HBV infection in foreign-born Asian Americans was characterized by a low rate of HBeAg (+) and male predominance as well as high rates of family history of HBV infection, hepatic fibrosis, and hepatic steatosis.

Contribution of lip proportions to facial aesthetics in different ethnicities: A three-dimensional analysis

Lip augmentations are commonly performed procedures in the United States, with annual numbers surpassing 100 000. While lips contribute to facial beauty, the relative influence of this feature to whole facial appeal has not yet been established. What is also of increasing interest is the consideration of ethnic differences in the evaluation of beauty. However, most current anthropometric measurements refer to Caucasians, and their use in the treatment of Asian American patients would be inappropriate. Three-dimensional models of 197 male and female Caucasian, Chinese and Korean subjects were created using surface-imaging technology. The lips and corresponding faces from these models were ranked according to subjective aesthetic appeal by 20 male and female raters of various ages, occupations and ethnicities. The raters' results were subsequently compared with individually measured lip parameters. Rankings between lips and their corresponding whole faces differed greatly. Lips that were rated as the most attractive were smaller than average in midline upper lip surface heights, bilateral paramedian lip surface heights, upper lip angles and volume in the lower lip. Both Asian groups exhibited significantly different lip parameters and lip-projection volumes from that of Caucasians. The results from this study suggest that there are indeed measurable differences in the baseline Asian lip morphology as compared with Caucasians. Tailoring lip enhancement treatment to each individual's anatomy, ethnic background and personal goals can optimise outcomes. What is also of interest is that lips did not contribute as much to facial attractiveness as previously thought.

Surveillance for Hepatocellular Carcinoma Improves Survival in Asian-American Patients with Hepatitis B: Results from a Community-Based Clinic

Hepatocellular carcinoma (HCC) is a common malignancy in Asians with hepatitis B virus infection. HCC patients often present with poor liver function and large tumors resulting in rapid mortality. The impact of HCC surveillance and subsequent therapy on patient survival remain controversial. We sought to determine if surveillance for HCC in a community-based clinic improve survival and, if so, identify factors that contribute to the benefit of early tumor detection. From 1991 to 2008, alpha-fetoprotein and abdominal ultrasound examination were used as surveillance tests for HCC. The survival of HCC patients detected by surveillance was compared to patients who presented to the clinic with HCC (no surveillance). An adjusted lead-time bias interval was added to the survival time of patients who presented with HCC. During this period, 26 patients with surveillance developed HCC while 52 patients presented with HCC. More surveillance patients had normal levels of alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase (p < 0.05-0.0001) and had tumors that were within Milan and University of California San Francisco (UCSF) criteria (p = 0.02-0.0001). The 1-, 3-, and 5-year survival rates were higher in surveillance patients and in those who received surgical or loco-regional therapies (p = 0.007-0.0001). On multivariate analysis, baseline independent factors predicting survival were single tumors (Hazard ratio [HR] 0.25, p = 0.0005), UCSF criteria (HR 0.29, p = 0.006), Child-Turcotte-Pugh class A (HR 0.45, p = 0.03), platelet counts per log(10) increase (HR 0.315, p = 0.04) and aspartate aminotransferase per log(10) increase (HR 5.7, p = 0.01). Surveillance for HCC identified patients with smaller tumor burdens and more adequate liver function who were able to receive more definitive therapies. HCC surveillance improves survival and should be included as standard of care for patients with hepatitis B.

Response to pegylated interferon and ribavirin in Asian American patients with Chronic hepatitis C genotypes 1 vs 2/3 vs 6

Chronic hepatitis C is generally underappreciated in Asian Americans, and most pivotal studies were conducted in western countries and only included a small numbers of Asian patients. Our goal was to examine and compare treatment outcomes in these patients with genotypes 1 vs 2/3 vs 6. We performed a retrospective cohort study of 167 consecutive treatment-naïve Asian American patients treated with pegylated interferon (PEG IFN) plus ribavirin (RBV) at two community clinics in Northern California from 12/00 to 1/08. Primary outcome was sustained virological response rate by intention-to-treat analysis. The overall completion rate was 76%, and treatment adherence (completion of ≥ 75-80% PEG IFN + RBV dose for ≥ 75-80% of intended duration) was 74%. Significant depression was noted in only 4% of patients. Sustained virologic response in patients with genotype 6 treated for 48 weeks was similar to that seen in those with genotype 2/3 (74%vs 75%, P = 0.89) and significantly higher than those with genotype 1 (74%vs 49%, P = 0.016). On multivariate analysis inclusive of sex, age, body mass index (≤ 25 vs > 25) and viral load, only treatment adherence and genotype (2/3 and 6 treated for 48 weeks) were found to be significant predictors of sustained virologic response. We conclude that significant depression is rare in Asian American patients (4%). Patients with genotype 6 treated for 48 weeks appear to have a similar treatment response rate as patients with genotype 2/3 and a significantly higher response rate than those with genotype 1.

Similar Treatment Response to Peginterferon and Ribavirin in Asian and Caucasian Patients With Chronic Hepatitis C

Previous studies have found ethnicity to be an important predictor of outcomes of treatment with peginterferon (PEG-IFN) and ribavirin (RBV) in chronic hepatitis C. Although the expected sustained virological response (SVR) rates of Hispanics and African Americans are lower than those of Caucasians, SVR rates in Asians appear to be more favorable. However, in some of these studies, hepatitis C virus (HCV) genotype was identified by INNO-LiPA assay, which can mistype the easier-to-treat HCV genotype 6 as genotype 1. Our goal was to compare SVR rates among Caucasian and Asian-American patients with genotype 1 and 2/3 infection whose HCV genotypes were accurately classified by core sequencing testing. A cohort of 269 consecutive treatment-naive HCV-infected patients with genotype 1 or 2/3 (157 Caucasians and 112 Asians) treated with PEG-IFN+RBV from January 2001 to November 2007 at four community-based gastroenterology clinics in Northern California were studied. The analysis of data was by intention-to-treat. The SVR rates for patients with genotype 1 were 45% for Caucasians and 52% for Asians (P=0.37). The SVR rates for patients with genotype 2/3 infection was 77% for Asians and 74% for Caucasians (P=0.7). On multivariate logistic regression analyses adjusting for age, alanine aminotransferase (ALT), baseline viral load, HCV genotype, and treatment adherence, we did not find Asian ethnicity to predict SVR. On a separate analysis, we found that Asians who had HCV genotype 1 or 1b by the less accurate INNO-LiPA assay had significantly higher SVR rates than Caucasians with genotype 1 (64% vs. 45%, respectively, P=0.03). SVR rates were similar in Asian Americans and Caucasians infected with HCV genotype 1 or 2/3 when HCV genotype classification was accurately determined.

Severity of Disease, Management and Complications Among Mexican Americans, African Americans and Caucasians with Inflammatory Bowel Disease in the County Hospital Setting

Purpose: Genetic and environmental factors play key roles in the pathogenesis of inflammatory bowel disease (IBD). Data is limited about the variability of IBD among minority ethnic groups such as African Americans and Mexican Americans. Methods: We performed a retrospective chart review of patients with IBD presenting from 1994 to 2008. We evaluated African American, Mexican American, Asian American and Caucasian patients with inflammatory bowel disease at the Lyndon B. Johnson county hospital. We included demographic characteristics, symptoms, severity of disease, management course and complications. Results: 74 patients with IBD were included, 28 Afican American (38%), 24 Mexican American (32%), 19 Caucasian (26%), and 3 Asians (4%). Among Mexican Americans, there were fewer female patients (46%) than male patients (54%). The incidence of Crohn's disease was greater in Caucasians (53%) as compared to both, Mexican Americans (29%) and African Americans (21%). There were no major differences in symptoms at presentation between the different ethnic groups. Pseudopolyps were more frequently found in Mexican Americans (50%) than Caucasians (10%) and African Americans (17%). A more profound anemia at presentation (hemoglobin < 10 mg%) was noted in African Americans (29%) and Mexican Americans (21%) in comparison to Caucasians (5%). 81% of patients were placed on 5-aminosalicylic acid agents without a difference in ethnic group. 63% of Caucasians received steroids versus 52% of African Americans and 45% of Mexican Americans. Immunomodulators were prescribed in 26% of Caucasians, 24% of African Americans and, 9% of Mexican Americans. Abscess or fistula formation was more common among Mexican Americans (20%) than Caucasians (5%) or African Americans (0%). Five patients had dysplasia or adenocarcinoma at time of presentation. Four patients were placed on biologic therapy. Conclusion: Although the presentation of inflammatory bowel disease among racial groups was similar in our population, the management and complications in Mexican Americans are different than African Americans and Caucasians. Mexican Americans are less likely to receive immunomodulators and more likely to have complications of disease.

Healthcare Experiences of Limited English-Proficient Asian American Patients

: Among patients with limited English-language proficiency (LEP), provider-patient language discordance is related to lower patient satisfaction. However, little is known about how language barriers are associated with specific patient experiences, and how these experiences in turn may influence patient satisfaction. : To evaluate the degree of health education and the quality of interpersonal care that occurs during patient visits, and their associations with patient satisfaction, in LEP Asian American patients. : A cross-sectional mail survey was conducted in 2746 LEP Chinese and Vietnamese patients aged ≥18 years from 11 community health centers in eight US cities. We examined self-reported healthcare experiences of LEP patients who had visits to a language concordant (speaks the patient's language) or discordant (does not speak the patient's language) provider over the previous month. Multivariable logistic regressions were conducted to examine the associations between interpersonal care, discussions of health-related behaviors, and patient satisfaction. : Discussions of health-related behaviors and the quality of interpersonal care received were independent predictors of patient satisfaction (p < 0.001). For language-discordant visits without access to an interpreter, patients who received poor-quality interpersonal care were more likely to be dissatisfied with the visit (adjusted odds ratio [AOR] 2.44; 95% CI 1.67, 3.57) and with the provider (AOR 4.43; 95% CI 1.71, 11.48) [both p < 0.01]. : Improving the quality of interpersonal care and the degree of health-related discussions may result in greater satisfaction among LEP patients. The quality of the provider's interpersonal care is especially important to patient satisfaction. Interpreter services may alleviate some disparities in care.

11 Treatment Response and Tolerability to Pegylated Interferon (PEG Inf) and Ribavirin (RBV) in Treatment-Naïve Asian American Patients with Chronic Hepatitis C and Genotype 1, 2/3 and 6

PURPOSE: The total number of individuals infected with the hepatitis C virus (HCV) from the Asia Pacific region is 4x greater than that from the Americas/Europe combined (94.5 vs. 22 million). Yet, Asians remain one of the least studied HCV patient groups. Our goal was to examine treatment outcomes and tolerability in this population. METHODS: A total of 199 consecutive treatment-naive AA patients treated with PEG IFN+RBV by 5 gastroenterologists at a U.S. community clinic in 12/00-1/08 were included in the study. Primary outcome was sustained-virological-response (SVR) rate by intention-to-treat analysis. Treatment adherence was defined as completion of ≥ 80% PEG IFN and RBV dose for ≥ 80% of intended duration. RESULTS: Mean age was 49 + 10, 63% were male, and 9% had cirrhosis. Treatment adherence rate was 39%. The most common side effect besides constitutional symptoms was anemia requiring erythropoietin (EPO): 27%. Significant depression was noted in only 1.5% of patients. SVR rate in genotypes 6 patients treated for 48 weeks was similar to that seen in genotypes 2/3 patients (81% vs. 88%, p=0.43) (Figure 1). Genotype 6 patients treated for 24 weeks had similar SVR to that of genotype 1 patients (56% vs. 59%, p=0.92). On multivariate analysis also inclusive of viral load and sex, independent predictors for SVR were treatment adherence (OR=5.86, p 25 (OR=0.88, p=0.048) and older age (OR=0.13, p 55. CONCLUSION: In Asian patients, older age >45, BMI>25 were associated with poorer SVR rates while treatment adherence strongly predicts a positive outcomes. Anemia requiring EPO is a common side effect (27%) while significant depression is rare (1.5%). Patients with genotype 6 can expect to have a favorable SVR rate as patients with genotype 2/3 if treated for 48 weeks.

Survival and hepatitis status among Asian Americans with hepatocellular carcinoma treated without liver transplantation

BackgroundChronic hepatitis B virus (HBV) and hepatitis C virus (HCV) are established causes of HCC. HCC patients are often diagnosed late and receive palliative therapies, however, the survival of Asian American patients with HCC treated without transplantation has not been well studied. We reviewed our institution's experience to determine predictors and rates of survival in Asian American HCC patients treated without transplantation.MethodsWe identified Asian American patients with HCC referred to M. D. Anderson Cancer Center. Patients were tested for HBV and HCV. Survival curves were generated by Kaplan-Meier method. Multivariate Cox proportional hazards regression was used to test the relationship between prognostic factors and survival.ResultsOf 82 Asian American HCC patients, most had advanced disease (65%) and received treatment (68%); however, only 11% had surgical resection. 94% had positive anti-HBc and 61% had positive HBsAg. 20% had positive anti-HCV. There were no significant changes in the rates of HBV and HCV over time. Male gender, high alpha-fetoprotein levels, and stage IV disease were associated with shorter survival Overall median survival was 9.2 months (95% CI 6.5–11.9), and the survival of HCV and HBV patients was not statistically different.ConclusionThe survival rate of Asian American patients with advanced HCC, for whom transplantation was not available, was low. Timely hepatitis screening and interventions by primary care physicians may be the most logical solution to reduce the burden of hepatitis-associated HCC among Asian Americans.

The Situation-Specific Theory of Pain Experience for Asian American Cancer Patients

Studies have indicated the need for theories that explain and target ethnic-specific cancer pain experiences, including those of Asian Americans. In this article, I present a situation-specific theory that explains the unique cancer pain experience of Asian Americans. Unlike other existing theories, this situation-specific theory was developed on the basis of evidence, including a systematic literature review and research findings, making it comprehensive and highly applicable to research and practice with Asian American patients with cancer. Thus, this theory would strengthen the interconnections among theory, evidence, and practice in pain management for Asian American cancer patients.

An apolipoprotein A-V gene SNP is associated with marked hypertriglyceridemia among Asian-American patients*s⃞

Apolipoprotein A-V (apoA-V) is an important regulator of plasma levels of triglyceride (TG) in mice. In humans, APOA5 genetic variation is associated with TG in several populations. In this study, we determined the effects of the p.185Gly>Cys (c.553G>T; rs2075291) polymorphism on plasma TG levels in subjects of Chinese ancestry living in the United States and in a group of non-Chinese Asian ancestry. The frequency of the less common cysteine allele was 4-fold higher (15.1% vs. 3.7%) in Chinese high-TG subjects compared with a low-TG group (Chi-square = 20.2; P < 0.0001), corresponding with a 4.45 times higher risk of hypertriglyceridemia (95% confidence interval, 2.18-9.07; P < 0.001). These results were replicated in the non-Chinese Asians. Heterozygosity was associated, in the high-TG group, with a doubling of TG (P < 0.001), mainly VLDL TG (P = 0.014). All eleven TT homozygotes had severe hypertriglyceridemia, with mean TG of 2,292 +/- 447 mg/dl. Compared with controls, carriers of the T allele had lower postheparin lipoprotein lipase activity but not hepatic lipase activity. In Asian populations, this common polymorphism can lead to profound adverse effects on lipoprotein profiles, with homozygosity accounting for a significant number of cases of severe hypertriglyceridemia. This specific apoA-V variant has a pronounced effect on TG metabolism, the mechanism of which remains to be elucidated.

Higher Rate of Sustained Virologic Response in Chronic Hepatitis C Genotype 6 Treated With 48 Weeks Versus 24 Weeks of Peginterferon Plus Ribavirin

Infection with hepatitis C virus (HCV) genotype 6 is common in patients from parts of China and Southeast Asia. No study to date has examined the treatment response to peginterferon and ribavirin (PEG IFN + RBV) in these patients, or the effects of treatment duration on sustained virologic response (SVR) rates. We performed a retrospective study of 190 consecutive Asian-American patients who were diagnosed with HCV genotype 6 at a gastroenterology clinic in northern California between 2001 and 2004, 66 of whom were treatment-naïve and subsequently completed 24 wk of IFN + RBV or PEG IFN + RBV or 48 wk of PEG IFN + RBV therapy. The primary outcome was SVR. There was no statistical difference in SVR of 31 patients treated with 24 wk of IFN + RBV and in 23 patients treated with 24 wk of PEG IFN + RBV (51.6%vs 39%, P= 0.363). The SVR in 12 patients treated with 48 wk of PEG IFN + RBV was significantly higher than that in those treated for only 24 wk (75%vs 39%, P= 0.044). Treatment-eligible patients with HCV genotype 6 should be treated with a full course of 48 wk as tolerated. Larger prospective studies of patients with HCV genotype 6 are needed to confirm the optimal treatment duration with PEG IFN + RBV.

M1911 Cost-Effectiveness of Screening for Hepatitis B Infection Among Asian-Americans Undergoing Chemotherapy

BACKGROUND: Although the cost-effectiveness of prophylactic lamivudine for patients with known hepatitis B virus (HBV) infection undergoing lymphoma treatment is well established, the cost effectiveness of screening persons with unknown HBV status prior to starting chemotherapy is unknown. Recent studies have shown that most cancer centers do not routinely perform such screening. We hypothesized that screening all high-risk patients for HBV prior to starting chemotherapy would be cost-effective. METHODS: For our base case, we considered a hypothetical cohort of 60 year old Asian-American males with Stage IIIV non-Hodgkin's lymphoma in whom chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) was planned. We used a decision analysis model to compare three competing strategies prior to initiation of chemotherapy: (1) no HBV prophylaxis, (2) prophylaxis with lamivudine only among patients with previously known HBV infection, and (3) screening all patients for HBV infection and giving prophylaxis to those found to be infected. We examined the cost effectiveness of each strategy over a time horizon of 1 year with no discounting. Sensitivity analysis was carried out on all variables, most notably prevalence of HBV infection and risk of reactivation. RESULTS: The universal screening strategy was associated with both a lower cost and higher effectiveness than the other two strategies. It remained the dominant strategy even if the prevalence of HBV infection fell to 1% (base case = 9%) or the risk of reactivation fell to 22% (base case = 43%). It also remained the preferred strategy over a wide range of costs for anti-viral medication, suggesting that newer agents such as entecavir and adefovir would be also be appropriate in this setting. CONCLUSION: Screening all Asian American patients for HBV infection prior to initiation of cytotoxic chemotherapy for lymphoma is highly cost-effective. The fact that it remains a preferred strategy even with a 1% prevalence of HBV infection suggests that screening might be advisable in lower-risk populations as well. Probabilities and Costs Used in Model

Prevalence of Pathogenic BRCA1 Mutation Carriers in 5 US Racial/Ethnic Groups

Information on the prevalence of pathogenic BRCA1 mutation carriers in racial/ethnic minority populations is limited. To estimate BRCA1 carrier prevalence in Hispanic, African American, and Asian American female breast cancer patients compared with non-Hispanic white patients with and without Ashkenazi Jewish ancestry. We estimated race/ethnicity-specific prevalence of BRCA1 in a population-based, multiethnic series of female breast cancer patients younger than 65 years at diagnosis who were enrolled at the Northern California site of the Breast Cancer Family Registry during the period 1996-2005. Race/ethnicity and religious ancestry were based on self-report. Weighted estimates of prevalence and 95% confidence intervals (CIs) were based on Horvitz-Thompson estimating equations. Estimates of BRCA1 prevalence. Estimates of BRCA1 prevalence were 3.5% (95% CI, 2.1%-5.8%) in Hispanic patients (n = 393), 1.3% (95% CI, 0.6%-2.6%) in African American patients (n = 341), and 0.5% (95% CI, 0.1%-2.0%) in Asian American patients (n = 444), compared with 8.3% (95% CI, 3.1%-20.1%) in Ashkenazi Jewish patients (n = 41) and 2.2% (95% CI, 0.7%-6.9%) in other non-Hispanic white patients (n = 508). Prevalence was particularly high in young (<35 years) African American patients (5/30 patients [16.7%]; 95% CI, 7.1%-34.3%). 185delAG was the most common mutation in Hispanics, found in 5 of 21 carriers (24%). Among African American, Asian American, and Hispanic patients in the Northern California Breast Cancer Family Registry, the prevalence of BRCA1 mutation carriers was highest in Hispanics and lowest in Asian Americans. The higher carrier prevalence in Hispanics may reflect the presence of unrecognized Jewish ancestry in this population.

Cancer screening practices of Asian American physicians in New York City.

Cancer screening rates are lower among Asian Americans than the general USA population. While prior studies examined characteristics of Asian American patients as predictors of cancer screening, few investigated their health care providers. Asian American primary care physicians practicing in New York City were surveyed by questionnaire regarding their demographics, practice characteristics, and cancer screening of their Asian American patients. Of the 117 eligible respondents, 96% recommended mammograms to their Asian patients 50+ years of age and 70% to patients 40-49-year-old. Only 30% of respondents use both age and onset of sexual activity to determine when to recommend Pap smears. For colorectal cancer screening, the rates of performing fecal occult blood testing or recommending colonoscopy or sigmoidoscopy were 77% and 74%. About 70% recommend screening for hepatitis B. Gender and ethnicity of the physician were found to be significant predictors for cancer screening practice.

Using the PHQ-9 for Depression Screening and Treatment Monitoring for Chinese Americans in Primary Care

Using the PHQ-9 for Depression Screening and Treatment Monitoring for Chinese Americans in Primary Care

Brief Reports: Psychiatric Illness and Substance Abuse Among Homeless Asian-American Veterans

Brief Reports: Psychiatric Illness and Substance Abuse Among Homeless Asian-American Veterans

Racial Identities, Racial Enactments, and Normative Unconscious Processes

The author surveys various views of racial and ethnic identity, and proposes a model of thinking about identity aimed at capturing both its oppressive and its facilitating character. To further elaborate the dual nature of identity, she discusses the way that inequities in the social world, and the ideologies that sustain them, produce narcissistic wounds that are then enacted consciously and unconsciously by both patient and therapist. A variety of such enactments are presented in a summary of the author’s work with an Asian American patient, during which she began to recognize unconscious racial and cultural underpinnings of some of the ways she has thought about certain “basics” of psychoanalytic practice: dependence, independence, happiness, and love.

Radiology Nursing with the Asian Population

Radiology nursing is a semiautonomous nursing specialty, with professional development requirements related to cultural competency. Standards of cultural competence in radiology nursing are presented and applied to the resolution of three encounters with Asian American patients based on real-life incidents. Recommendations are offered for personal and organizational enhancement of cultural competency as a strategy for quality improvement in patient care, especially for the Asian American population.

Racial Disparities in Outcomes of Inpatient Stroke Rehabilitation

Bhandari VK, Kushel M, Price L, Schillinger D. Racial disparities in outcomes of inpatient stroke rehabilitation. Objective To determine whether race is associated with outcomes of inpatient stroke rehabilitation. Design Retrospective cohort study. Setting A community-based inpatient rehabilitation facility. Participants Poststroke patients (N=1002) admitted to a community-based inpatient rehabilitation facility between 1995 and 2001. Interventions Not applicable. Main Outcome Measures Functional improvement at discharge from the rehabilitation facility, discharge disposition, and functional improvement at 3 months after discharge. Inpatient and follow-up data were collected from the facility’s electronic patient database. We used the FIM instrument to assess functional status at admission, discharge, and follow-up. Results In multivariable models, blacks achieved less functional improvement at discharge (–1.9 FIM points, P=.02) compared with whites and, despite worse FIM scores, were more likely to be discharged to home (adjusted odds ratio=1.7; 95% confidence interval, 1.1–2.5). Although Asian-American patients did not differ from whites in terms of functional improvement at discharge or disposition, they had less improvement at 3 months following discharge (–6.3 FIM points, P=.005). Conclusions We identified racial disparities in poststroke outcomes in a community-based inpatient rehabilitation facility. Future research in stroke rehabilitation should explore the consistency of these findings across settings and if they are confirmed, identify explanatory mediators to better inform efforts to eliminate racial disparities.