Black-white Differences Research Articles

Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries

The Comprehensive Care for Joint Replacement (CJR) model was designed to reduce the cost and improve the quality of hip or knee replacement among Medicare beneficiaries. Yet whether this model may exacerbate existing racial/ethnic disparities in access to the surgery is unclear. To examine the association of the CJR model with the receipt of elective hip or knee replacement across White, Black, and Hispanic Medicare beneficiaries. Retrospective cohort study of Medicare claims from 2013 through 2017 among White, Black, and Hispanic Medicare beneficiaries undergoing elective joint replacement in 65 treatment (selected for CJR participation) and 101 control metropolitan statistical areas (MSAs). Starting in April 2016, hospitals in the treatment MSAs were required to participate in the CJR model and were accountable for expenditures occurring during patients' hospitalization for hip or knee replacement and 90 days after the hospital discharge. Beneficiary-level elective hip or knee replacement receipt in a given year. Among 17 243 304 patients, 9 839 996 (57%) were women; 2 107 425 (12%) were age 85 years or older. Of the final sample, 14 632 434 (85%) were White beneficiaries, 1 518 629 (9%) were Black beneficiaries, and 1 092 241 (6%) were Hispanic beneficiaries. The CJR model was associated with an increase of 1.6 elective hip or knee replacements per 1000 beneficiary-years for Hispanic beneficiaries (95% CI, 0.06-2.05) and a decrease of 0.64 replacements for Black beneficiaries (95% CI, -1.25 to -0.02). No evidence was found for any changes for White beneficiaries per 1000 beneficiary-years (0.04 replacements, 95% CI, -0.35 to 0.42 replacements). The Black-White difference in the rate of elective hip or knee replacement per 1000 beneficiary-years further widened by 0.68 replacements (-0.68, 95% CI, -1.20 to -0.15). In this cohort study, the CJR model was associated with increased receipt of elective hip or knee replacement among Hispanic beneficiaries, decreased receipt among Black beneficiaries, and no change in receipt among White beneficiaries. The decreased receipt of elective hip or knee replacement among Black beneficiaries may suggest that value-based payment models, including the CJR model, could be monitored for unintended consequences. However, the lack of similar findings among Hispanic beneficiaries suggests that payment models may have differential impacts across racial/ethnic groups.

Black-White Differences in the Link Between Offspring College Attainment and Parents' Depressive Symptom Trajectories.

This study examines whether the relationship between children's college attainment and their parents' mental health differs for Black and White parents as they age. Data come from the U.S. Health and Retirement Study (HRS) and multilevel growth curve models are used to assess parents' depressive symptom trajectories. Results indicated that parents over age 50 whose children all completed college had significantly lower initial levels of depressive symptoms than those with no college-educated children. The initial benefit was stronger for Blacks than Whites. Results stratified further by parents' education show that Black parents at nearly all levels of schooling experienced stronger returns to their mental health from children's college completion compared to White parents, for whom only those with a high school education showed an inverse association between offspring education and depression symptoms. The findings underscore how offspring education is a potential resource for reducing disparities in health across families.

Abstract P672: Black White Disparity in Multiple Risk Factors is Increased in Older Young Adults

Background: Stroke in young adults constitutes 15-18% of all ischemic strokes. Vascular risk factors contribute to stroke risk in young adults particularly older young adults. Few studies have addressed Black White differences in risk, stratified by age. We evaluated the prevalence of risk factors in the younger young (less than 40 years) vs. the older young adults (40 and above). Methods: A population based case control study with 1034 cases and 1091 controls, ages 15-49 was used to investigate the relationship between risk factors (DM, HTN, Smoking and Obesity) and stroke. Groups were defined by the number of risk factors (RF) among cases and controls : no risk factors (ref group), one RF, two RF, three RF and four RF. Prevalence of risk factors was determined in the entire population and stratified by age, sex and race. Logistic regression was used to determine odds of stroke based on the number of risk factors compared to the reference group. Results: The percent of cases with three or more risk factors was compared in different subgroups: ages 15-39 vs. 40-49 was 8.4 vs. 21.6, women vs. men was 15.6 vs. 18.6 and White vs. Black was 12.3 vs. 22.7. Among cases 40 years and older, Blacks were 3 times more likely than Whites (5.9 vs. 2) to have four or more risk factors.Across all age, race and sex subgroups, the odds of having a stroke increased exponentially with an increase in the number of risk factors. Conclusion: Blacks are more likely to have multiple risk factors than Whites. This difference is accentuated in those 40 years and older. Targeting young adults with multiple risk factors for preventive interventions would address a root case of excess stroke risk especially among Blacks.

Patterns of black and white hysterectomy incidence among reproductive aged women.

To investigate the intersection of race and economic context in treatment with hysterectomy among reproductive aged women with noncancerous gynecologic conditions. We combined administrative billing records of inpatient and outpatient hysterectomy procedures (N=28301) occurring in North Carolina between 2011 and 2014 with census data to calculate county-level hysterectomy rates. Spatial analysis techniques examined the distribution of black and white hysterectomy rates across counties, and county-level black and white rate differences were compared across economic contexts. We restricted to those of premenopausal age identifying as non-Hispanic black or white, undergoing hysterectomy for nonemergent causes (N=28301 procedures). County-level hysterectomy rates were spatially patterned (Moran's I, P<.05) and similarly so for black and white women (LISA, P<.005). The black-white difference in hysterectomy rates was the largest in the high economic tier counties (22/10000 person-years [PY], P<.05) and smallest in the mid and low economic tier counties (11/10000 PY, P>.05 and 10/10000 PY, P>.05, respectively). Socioeconomic context is important to understand, particularly for black-white disparities in hysterectomy. Efforts should be made to understand the causes of higher rates of hysterectomy among blacks than whites, especially in counties in the highest economic tier.

Black-White Differences in the Reciprocal Relationship Between Perceived Discrimination and Psychological Distress

ABSTRACT We formulate a MIDUS longitudinal data-based multi-population LISREL model to gauge variation among Black and White Americans in the reciprocal relationship across time between perceived major and everyday discrimination, and psychological distress. Two hypotheses building on prior theory and empirical findings are generated: reciprocity between perceived discrimination and distress, and stronger reciprocity among Blacks. Here, “reciprocity” denotes positive effects of perceived discrimination and mental health problems such as distress on each other across time. Both hypotheses are supported for relationships between perceived everyday discrimination and distress. The model controls for several potentially relevant variables.

Racial/Ethnic Disparities in All-Cause Mortality among Patients Diagnosed with Triple-Negative Breast Cancer.

It is unclear whether racial/ethnic disparities in triple-negative breast cancer (TNBC) mortality remain after accounting for clinical characteristics, treatment, and access-to-care-related factors. In this study, women with a primary diagnosis of TNBC during 2010-2014 were identified from the National Cancer Database. Hazard ratios (HR) and 95% confidence intervals (CI) for 3- and 5-year all-cause mortality associated with race/ethnicity were estimated using Cox proportional hazards models with stepwise adjustments for age, clinical characteristics, treatment, and access-to-care-related factors. Of 78,708 patients, non-Hispanic (NH) black women had the lowest 3-year overall survival rates (79.4%), followed by NH-whites (83.1%), Hispanics (86.0%), and Asians (87.1%). After adjustment for clinical characteristics, NH-blacks had a 12% higher risk of dying 3 years post-diagnosis (HR, 1.12; 95% CI, 1.07-1.17), whereas Hispanics and Asians had a 24% (HR, 0.76; 95% CI, 0.70-0.83) and 17% (HR, 0.83; 95% CI, 0.73-0.94) lower risk than their NH-white counterparts. The black-white disparity became non-significant after combined adjustment for treatment and access-to-care-related factors (HR, 1.04; 95% CI, 0.99-1.09), whereas the white-Hispanic and white-Asian differences remained. Stratified analyses revealed that among women aged less than or equal to 50 with stage III cancer, the elevated risk among NH-blacks persisted (HR, 1.20; 95% CI, 1.04-1.39) after full adjustments. Similar results were seen for 5-year mortality. Overall, clinical characteristics, treatment, and access-to-care-related factors accounted for most of the white-black differences in all-cause mortality of TNBC but explained little about Hispanic- and Asian-white differences. SIGNIFICANCE: These findings highlight the need for equal healthcare to mitigate the black-white disparity and for investigations of contributors beyond healthcare for lower mortality among Asians and Hispanics.

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

167 Severe maternal morbidity and black-white differences in Washington State

Rates of severe maternal morbidity (SMM) are significantly higher among black women and some data suggests further worsening of these rates among hospitals with the highest proportion of black deliveries. In this study, we sought to examine whether black women have higher SMM in Washington State and whether this varied by hospital. We conducted a retrospective cohort study using linked birth-hospital discharge data from Washington State. We included only women with black and white races and excluded observations with missing hospital information. SMM was defined using an already published algorithm. We ranked hospitals into low-, medium- and high black-serving hospitals by using proportions of deliveries to black women among all deliveries. Multivariable logistic regression models were used to examine the association of black women with SMM adjusted for demographics, co-morbidities and clustering within hospital. In the cohort of 407,808 women, 4,556 (1.12%) had SMM. High black-serving hospitals had the highest rate of SMM (1.94%) as compared to medium black-serving hospitals (1.16%) and low black-serving hospitals (1.06%) (p<0.01). Odds of SMM was higher in black women (OR=1.58, 95% CI: 1.39-1.78) and remained elevated after adjusting for demographics and the level of black-serving hospital (aOR= 1.29, 95% CI: 1.11-1.49). We found that the risk of SMM was higher among black women. Hospital level performance and health outcomes stratified by maternal race and ethnicity in hospitals and hospital systems should be addressed to further reduce disparities and optimize outcomes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Complexity of Health Disparities: More Than Just Black–White Differences

Health disparities have once again moved to the forefront of America's consciousness with the recent significant observation of dramatically higher death rates among African Americans with COVID-19 when compared to White Americans. Health disparities have a long history in the United States, yet little consideration has been given to their impact on the clinical outcomes in the rehabilitative health professions such as speech-language pathology/audiology (SLP/A). Consequently, it is unclear how the absence of a careful examination of health disparities in fields like SLP/A impacts the clinical outcomes desired or achieved. The purpose of this tutorial is to examine the issue of health disparities in relationship to SLP/A. This tutorial includes operational definitions related to health disparities and a review of the social determinants of health that are the underlying cause of such disparities. The tutorial concludes with a discussion of potential directions for the study of health disparities in SLP/A to identify strategies to close the disparity gap in health-related outcomes that currently exists.

Association Between Racial Disparities in Hospital Length of Stay and the Hospital Readmission Reduction Program.

Background:On average Black patients have longer LOS than comparable White patients. Longer hospital length of stay (LOS) may be associated with higher readmission risk. However, evidence suggests that the Hospital Readmission Reduction Program (HRRP) reduced overall racial differences in 30-day adjusted readmission risk. Yet, it is unclear whether the HRRP narrowed these LOS racial differences.Objective:We examined the relationship between Medicare-insured Black-White differences in average, adjusted LOS (ALOS) and the HRRP’s implementation and evaluation periods.Methods:Using 2009-2017 data from State Inpatient Dataset from New York, New Jersey, and Florida, we employed an interrupted time series analysis with multivariate generalized regression models controlling for patient, disease, and hospital characteristics. Results are reported per 100 admissions.Results:We found that for those discharged home, Black-White ALOS differences significantly widened by 4.15 days per 100 admissions (95% CI: 1.19 to 7.11, P < 0.001) for targeted conditions from before to after the HRRP implementation period, but narrowed in the HRRP evaluation period by 1.84 days per 100 admissions for every year-quarter (95% CI: −2.86 to −0.82, P < 0.001); for those discharged to non-home destinations, there was no significant change between HRRP periods, but ALOS differences widened over the study period. Black-White ALOS differences for non-targeted conditions remained unchanged regardless of HRRP phase and discharge destination.Conclusion:Increased LOS for Black patients may have played a role in reducing Black-White disparities in 30-day readmission risks for targeted conditions among patients discharged to home.

White-Black differences in tech tilt: Support for Spearman's law and investment theories

Tilt refers to an ability bias and is based on within subject differences between two abilities, indicating strength in one ability (e.g., math) and weakness in another ability (e.g., verbal). The current study examined tech tilt for Whites and Blacks, two groups with an average ability difference (favoring Whites) of about one standard deviation on tests of general intelligence (g). Tech tilt was based on differences in technical (mechanical, electronic) and academic (math or verbal) abilities on the Armed Services Vocational Aptitude Battery. These differences produced tech tilt (tech > academic) and academic tilt (academic > tech). Tech tilt correlated negatively with math and verbal abilities on college tests (SAT, ACT, PSAT), with weaker effects for Whites. White-Black differences in relations of tech tilt with the college tests were neutralized after removing g. In addition, tech tilt predicted jobs and college majors in STEM (science, technology, engineering, math). Relations of tech tilt with STEM criteria were generally larger (and more often significant) for Whites, but only for tech tilt based on technical and verbal abilities. The results are consistent with Spearman's Law of Diminishing Returns (SLODR). SLODR assumes that relations among tests should be weaker for higher ability groups (Whites compared to Blacks) and that non-g variance (related to non-ability factors such as vocational choice) should be more pronounced for higher ability groups. The negative relations of tech tilt with college tests support investment theories, which assume that investment in one ability (technical) comes at the expense of competing abilities (academic).

Human Capital and Black-White Earnings Gaps, 1966-2017

This paper estimates the contribution of human capital, measured using both educational attainment and test performance, to the Black-white earnings gap in three separate samples of men spanning 1966 through 2017. There are three main findings. First, the magnitude of reductions in the Black-white earnings gap that occur after controlling for human capital have become much larger over time, suggesting a growing contribution of human capital to Black-white earnings disparities. Second, these increases are almost entirely due to growth in the returns to human capital, rather than changing racial gaps in the human capital traits themselves. Finally, growth in the explanatory power of human capital has been primarily due to increases in the association between human capital and the likelihood of non-work, with no clear increases in the extent to which human capital explains Black-white differences in hourly wages or other intensive margins. These findings highlight how apparently race-neutral structural developments in the US labor market, such as increasing skill prices and falling labor force participation rates among less skilled men, have had large impacts on the dynamics of racial inequality. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Identifying Taste-Based Discrimination: Effect of Black Electoral Victories on Racial Prejudice and Economic Gaps

I test for the causal impact of Black electoral victories in local elections on White Americans’ attitude toward Black Americans. Using Race Implicit Attitude Test scores as a measure of racial prejudice and close-election regression-discontinuity design for causal inference, I find Black electoral victories cause measures of racial bias to rise, by 4% of the average Black-White difference in IAT scores. Simultaneously, they widen racial gaps in unemployment and mortgage denials. Interpreting these close electoral victories as instrumental variables, I find a large causal effect of prejudice-based racial discrimination on Black-White economic gaps.

Ventricular Assist Device Technology and Black-White Disparities on the Heart Transplant Wait List.

Heart transplantation is the definitive treatment for end-stage heart failure. Left ventricular assist devices (LVADs) are a continually improving technology that extends life for some candidates on the heart transplant waiting list. Research Questions: Our objective is to compare Black-White differences in LVAD implantation and heart transplant outcomes during a period of technological innovation when the pulsatile flow LVAD was largely replaced by the continuous flow LVAD between 1999-2014. We used transplant registry data from the United Network for Organ Sharing (N = 5,550) to identify Black and White patients with heart failure who used an LVAD as a bridge-to-transplant (BTT). Using logistic regression, we compared Black-White differences in access to newer LVAD technology and timing of implantation relative to wait listing for heart transplantation. We used competing-risks event history models to predict transplant outcomes across race, LVAD type, and timing of LVAD implantation. Black and White candidates were equally likely to receive newer continuous flow LVADs, but Black candidates received LVADs later in the disease course (i.e. after transplant listing). This later timing of technological intervention contributed to poorer wait list outcomes among black transplant candidates, including lower likelihood of receiving a heart transplant and greater likelihood of being removed from the wait list due to worsening health. Delayed LVAD implantation is more common among Black patients and is associated with poorer transplant outcomes.

C-Reactive Protein and Incident Hypertension in Black and White Americans in the REasons for Geographic And Racial Differences in Stroke (REGARDS) Cohort Study.

More inflammation is associated with greater risk incident hypertension, and Black United States (US) adults have excess burden of hypertension. We investigated whether increased inflammation as quantified by higher C-reactive protein (CRP) explains the excess incidence in hypertension experienced by Black US adults. We included 6,548 Black and White REasons for Geographic and Racial Differences in Stroke (REGARDS) participants without hypertension at baseline (2003-2007) who attended a second visit (2013-2016). Sex-stratified risk ratios (RRs) for incident hypertension at the second exam in Black compared to White individuals were estimated using Poisson regression adjusted for groups of factors known to partially explain the Black-White differences in incident hypertension. We calculated the percent mediation by CRP of the racial difference in hypertension. Baseline CRP was higher in Black participants. The Black-White RR for incident hypertension in the minimally adjusted model was 1.33 (95% confidence interval 1.22, 1.44) for males and 1.15 (1.04, 1.27) for females. CRP mediated 6.6% (95% confidence interval 2.7, 11.3%) of this association in females and 19.7% (9.8, 33.2%) in males. In females, CRP no longer mediated the Black-White RR in a model including waist circumference and body mass index, while in males the Black-White difference was fully attenuated in models including income, education and dietary patterns. Elevated CRP attenuated a portion of the unadjusted excess risk of hypertension in Black adults, but this excess risk was attenuated when controlling for measures of obesity in females and diet and socioeconomic factors in males. Inflammation related to these risk factors might explain part of the Black-White disparity in hypertension.

Black-White Differences in Hearing Problems Among Older Americans: Findings From Two Large Representative Surveys

The purpose of this study is to investigate Black-White differences in hearing problems among older adults living in the United States. Secondary data analyses were conducted using the 2017 American Community Survey (ACS) with a replication analysis in the 2016 ACS. The ACS is an annual nationally representative survey of Americans living in community settings and institutions. The sample size of older Americans (age 65+) in 2017 was 467,789 Non-Hispanic Whites (NHW) and 45,105 Non-Hispanic Blacks (NHB). In the 2016 ACS, there were 459,692 NHW and 45,990 NHB respondents aged 65+. Measures of hearing problems, age, race/ethnicity, education level and household income were based on self-report. Data were weighted to adjust for non-response and differential selection probabilities. The prevalence of hearing problems was markedly higher among older NHW (15.4% in both waves) in comparison to NHB (9.0% in 2017; 9.4% in 2016; both p<.001). In the 2017 ACS, the age-sex adjusted odds of hearing loss were 69% higher for NHW compared to NHB, which increased to 91% higher odds when household income and education level were taken into account (OR=1.91; 95% CI=1.85, 1.97). Further analyses by 10 year age cohorts indicated comparable findings (fully adjusted ORs range from 1.89 to 1.98). Findings from the 2016 ACS were very similar (e.g., 65+ fully adjusted OR=1.81). NHW have a much higher prevalence and almost double the odds of hearing loss compared NHB. Future research should investigate if melanin plays an otoprotective role through enhancing the antioxidant capability of cochlea.

The Black-White Mental Health Paradox Among Older Adults: Evidence From the Health and Retirement Study

Most studies of middle-aged adults find blacks have higher levels of psychological distress compared to whites but have lower risk of common psychiatric disorders. For instance, there is evidence of lower rates of depressive and anxiety disorders among blacks relative to whites despite large disparities in stress, discrimination and physical health in midlife—commonly referred to as the black-white mental health paradox. We examine evidence of the black-white paradox in anxiety and depressive symptoms among older adults. Data come from 6,019 adults ages 52+ from the 2006 Health and Retirement Study. Unadjusted models show older blacks report more anxiety and depressive symptoms than whites. After adjusting for socioeconomic factors, everyday discrimination, chronic conditions, and chronic stress, there are no black-white differences in anxiety and depressive symptoms. Findings suggest the black-white mental health paradox only extends into older adulthood for blacks living under similar stress and health landscapes as whites.

Discrimination, Stress, and Health Across the Life Course

There is a paucity of research that seeks to understand why race disparities in health across the life course remain elusive. Two such explanations that have been garnering attention is stress and discrimination. This symposium contains papers seeking to address the impact of discrimination or stress on African American health or health disparities across the life course. First, Nguyen and colleagues examine 1) the associations between discrimination and objective and subjective social isolation and 2) how these associations vary by age in using data from the National Survey of American Life. Discrimination was positively associated with being subjectively isolated from friends only and family only. This relationship varied by age. Discrimination did not predict objective isolation. Second, Brown examines evidence of the black-white paradox in anxiety and depressive symptoms among older adults using data from 6,019 adults ages 52+ from the 2006 HRS. After adjusting for socioeconomic factors, everyday discrimination, chronic conditions, and chronic stress, there are no black-white differences in anxiety and depressive symptoms. Third, Cobb and colleagues investigate the joint consequences of multiple dimensions of perceived discrimination on mortality risk using mortality data from the 2006-2016 HRS. The authors report the number of attributed reasons for everyday discrimination is a particularly salient risk factor for mortality in later life. This collection of papers provides insights into how discrimination or stress impacts African American health or health disparities in middle to late life.

Is the Black-White mental health paradox consistent across age, gender, and psychiatric disorders?

Objectives The Black-White mental health epidemiological paradox (i.e. Black Americans’ lower or similar rates of mental disorder relative to Whites) characterizes the literature on race and mental health. Yet, research has generally paid less attention to how such findings may vary across other social statuses that shape mental health. This study assessed whether the Black-White paradox is consistent across gender, age groups, and psychiatric disorders, including lifetime mood, anxiety, and substance use disorders. Method We used data from the National Comorbidity Survey-Replication (NCS-R) and National Survey of American Life (NSAL), 2001–2003 (N = 4,591 African Americans; 6,668 non-Hispanic Whites). Psychiatric disorders were measured with the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview (WMH-CIDI). Binary logistic regression models were conducted to assess racial patterns of lifetime mental disorders across age and gender. Wald tests were performed to assess age and gender group differences in Black-White patterns of mental disorder. Results The Black-White mental health paradox generally extends across lifetime mood, anxiety, and substance use disorders and is consistent across age and gender groups. One exception is middle-aged (45–64 years) Black men, who had higher odds of lifetime substance use disorder relative to their White male middle-aged peers. This difference is no longer statistically significant after accounting for education and employment. We also found more similarity in mental disorders between older Blacks and Whites relative to their younger counterparts, suggesting that Black-White mental health differences are most pronounced among younger age groups. Conclusion Our findings contribute to the broader literature on the Black-White mental health paradox by demonstrating that this epidemiological pattern persists across various mental disorder types and, at times, depends on age group and gender. Given that Black-Whte differences are less pronounced among older adults, future research should consider the ways life course theory might inform our understanding of the paradox. Findings also suggest that substance use services are critical to address the needs of middle-aged Black men of lower socioeconomic status who are disproportionately affected by substance use disorder, yet have relatively lower mental health care utilization rates.

Racial Differences in Atrial Cardiopathy Phenotypes in Patients With Ischemic Stroke.

To test the hypothesis that thrombogenic atrial cardiopathy may be relevant to stroke-related racial disparities, we compared atrial cardiopathy phenotypes between Black vs White patients with ischemic stroke. We assessed markers of atrial cardiopathy in the Greater Cincinnati/Northern Kentucky Stroke Study, a study of stroke incidence in a population of 1.3 million. We obtained ECGs and reports of echocardiograms performed during evaluation of stroke during the 2010/2015 study periods. Patients with atrial fibrillation (AF) or flutter (AFL) were excluded. Investigators blinded to patients' characteristics measured P-wave terminal force in ECG lead V1 (PTFV1), a marker of left atrial fibrosis and impaired interatrial conduction, and abstracted left atrial diameter from echocardiogram reports. Linear regression was used to examine the association between race and atrial cardiopathy markers after adjustment for demographics, body mass index, and vascular comorbidities. Among 3,426 ischemic stroke cases in Black or White patients without AF/AFL, 2,391 had a left atrial diameter measurement (mean, 3.65 ± 0.70 cm). Black race was associated with smaller left atrial diameter in unadjusted (β coefficient, -0.11; 95% confidence interval [CI], -0.17 to -0.05) and adjusted (β, -0.15; 95% CI, -0.21 to -0.09) models. PTFV1 measurements were available in 3,209 patients (mean, 3,434 ± 2,525 μV*ms). Black race was associated with greater PTFV1 in unadjusted (β, 1.59; 95% CI, 1.21-1.97) and adjusted (β, 1.45; 95% CI, 1.00-1.80) models. We found systematic Black-White racial differences in left atrial structure and pathophysiology in a population-based sample of patients with ischemic stroke. This study provides Class II evidence that atrial cardiopathy phenotypes differ in Black people with acute stroke compared to White people.