Disparities In Stroke Mortality Research Articles

Rural-urban stroke mortality gaps in the United States

IntroductionDisparities in stroke outcomes, influenced by the use of systemic thrombolysis, endovascular therapies, and rehabilitation services, have been identified. Our study assesses these disparities in mortality after stroke between rural and urban areas across the United States (US). MethodsWe analyzed the CDC data on deaths attributed to cerebrovascular disease from 1999 to 2020. Data was categorized into rural and urban regions for comparative purposes. Age-adjusted mortality rates (AAMR) were computed using the direct method, allowing us to examine the ratios of rural to urban deaths for the cumulative population and among demographic subpopulations. Linear regression models were used to assess temporal changes in mortality ratios over the study period, yielding beta-coefficients (β). ResultsThere was a total of 628,309 stroke deaths in rural regions and 2,556,293 stroke deaths within urban regions. There were 1.13 rural deaths for each one urban death per 100,000 population in 1999 and 1.07 in 2020 (β = −0.001, ptrend = 0.41). The rural-urban mortality ratio in Hispanic populations decreased from 1.32 rural deaths for each urban death per 100,000 population in 1999 to 0.85 in 2020 (β = −0.011, ptrend < 0.001). For non-Hispanic populations, mortality remained stagnant with 1.12 rural deaths for each urban death per 100,000 population in 1999 and 1.07 in 2020 (β = −0.001, ptrend = 0.543). Regionally, the Southern US exhibited the highest disparity with a urban-rural mortality ratio of 1.19, followed by the Northeast (1.13), Midwest (1.04), and West (1.01). ConclusionsOur findings depict marked disparities in stroke mortality between rural and urban regions, emphasizing the importance of targeted interventions to mitigate stroke-related disparities.

Sherman Lecture: Are We Aiming at the Correct Targets to Reduce Disparities in Stroke Mortality? Celebration, Reflection, and Redirection.

Although deaths from stroke have been reduced by 75% in the past 54 years, there has been virtually no reduction in the relative magnitude of Black-to-White disparity in stroke deaths, or the heavier burden of stroke deaths in the Stroke Belt region of the United States. Furthermore, although the rural-urban disparity has decreased in the past decade, this reduction is largely attributable to an increased stroke mortality in the urban areas, rather than reduced stroke mortality in rural areas. We need to focus our search for interventions to reduce disparities on those that benefit the disadvantaged populations, and support this review using relatively recently developed statistical approaches to estimate the magnitude of the potential reduction in the disparities.

Trends in Demographic and Geographic Disparities in Stroke Mortality Among Older Adults in the United States

Stroke is a leading cause of morbidity and mortality in the United States (US) among older adults. However, the impact of demographic and geographic risk factors remains ambiguous. A clear understanding of these associations and updated trends in stroke mortality can influence health policies and interventions. This study characterizes stroke mortality among older adults (age ≥ 55) in the US from January 1999 to December 2020, sourcing data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. Segmented regression was used to analyze trends in crude mortality rate (CMR) and age-adjusted mortality rate (AAMR) per 100,000 individuals stratified by stroke subcategory, sex, ethnicity, urbanization, and state. 3,691,305 stroke deaths occurred in older adults in the US between 1999 and 2020 (AAMR = 233.3), with an overall decrease in AAMR during these years. The highest mortality rates were seen in non-specified stroke (AAMR = 173.5), those 85 or older (CMR = 1276.7), men (AAMR = 239.2), non-Hispanic African American adults (AAMR = 319.0), and noncore populations (AAMR = 276.1). Stroke mortality decreased in all states from 1999 to 2019 with the greatest and least decreases seen in California (-61.9%) and Mississippi (-35.0%), respectively. The COVID-19 pandemic saw increased stroke deaths in most groups. While there's a decline in stroke-related deaths among US older adults, outcome disparities remain across demographic and geographic sectors. The surge in stroke deaths during COVID-19 reaffirms the need for policies that address these disparities.

Impact of State Stroke Systems of Care Laws on Stroke Outcomes.

Since 2003, 38 US states and Washington, DC have adopted legislation and/or regulations to strengthen stroke systems of care (SSOCs). This study estimated the impact of SSOC laws on stroke outcomes. We used a coded legal dataset of 50 states and DC SSOC laws (years 2003-2018), national stroke accreditation information (years 1997-2018), data from the Healthcare Cost and Utilization Project (years 2012-2018), and National Vital Statistics System (years 1979-2019). We applied a natural experimental design paired with longitudinal modeling to estimate the impact of having one or more SSOC policies in effect on outcomes. On average, states with one or more SSOC policies in effect achieved better access to primary stroke centers (PSCs) than expected without SSOC policies (ranging from 2.7 to 8.0 percentage points (PP) higher), lower inpatient hospital costs (USD 610-1724 less per hospital stay), lower age-adjusted stroke mortality (1.0-1.6 fewer annual deaths per 100,000), a higher proportion of stroke patients with brain imaging results within 45 min of emergency department arrival (3.6-5.0 PP higher), and, in some states, lower in-hospital stroke mortality (5 fewer deaths per 1000). Findings were mixed for some outcomes and there was limited evidence of model fit for others. No effect was observed in racial and/or rural disparities in stroke mortality.

Stroke Mortality Among Black and White Adults Aged ≥35 Years Before and During the COVID-19 Pandemic — United States, 2015–2021

Stroke is the fifth leading cause of death and a leading cause of long-term disability in the United States (1). Although stroke death rates have declined since the 1950s, age-adjusted rates remained higher among non-Hispanic Black or African American (Black) adults than among non-Hispanic White (White) adults (1,2). Despite intervention efforts to reduce racial disparities in stroke prevention and treatment through reducing stroke risk factors, increasing awareness of stroke symptoms, and improving access to treatment and care for stroke (1,3), Black adults were 45% more likely than were White adults to die from stroke in 2018.* In 2019, age-adjusted stroke death rates (AASDRs) (stroke deaths per 100,000 population) were 101.6 among Black adults and 69.1 among White adults aged ≥35 years. Stroke deaths increased during the early phase of the COVID-19 pandemic (March-August 2020), and minority populations experienced a disproportionate increase (4). The current study examined disparities in stroke mortality between Black and White adults before and during the COVID-19 pandemic. Analysts used National Vital Statistics System (NVSS) mortality data accessed via CDC WONDER† to calculate AASDRs among Black and White adults aged ≥35 years prepandemic (2015-2019) and during the pandemic (2020-2021). Compared with that during the prepandemic period, the absolute difference in AASDR between Black and White adults during the pandemic was 21.7% higher (31.3 per 100,000 versus 38.0). During the pandemic period, an estimated 3,835 excess stroke deaths occurred among Black adults (9.4% more than expected) and 15,125 among White adults (6.9% more than expected). These findings underscore the importance of identifying the major factors contributing to the widened disparities; implementing prevention efforts, including the management and control of hypertension, high blood cholesterol, and diabetes; and developing tailored interventions to reduce disparities and advance health equity in stroke mortality between Black and White adults. Stroke is a serious medical condition that requires emergency care. Warning signs of a stroke include sudden face drooping, arm weakness, and speech difficulty. Immediate notification of Emergency Medical Services by calling 9-1-1 is critical upon recognition of stroke signs and symptoms.

Differences in Geographic Patterns of Absolute and Relative Black-White Disparities in Stroke Mortality in the United States.

Preventing Chronic Disease (PCD) is a peer-reviewed electronic journal established by the National Center for Chronic Disease Prevention and Health Promotion. PCD provides an open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

Rural-urban differences in stroke risk

Rural-urban health disparities in life expectancy are large and increasing, with the rural-urban disparity stroke mortality serving as a potential contributor. Data from Vital Statistics shows an unexplained temporal pattern in the rural-urban disparity in stroke-specific mortality, with the magnitude of the disparity increasing from 15% to 25% between 1999 and 2010, but subsequently decreasing to 8% by 2019. This recent decrease in the magnitude of the rural-urban disparity in stroke mortality appears to be driven by a previously unreported plateauing of stroke mortality in urban areas and a continued decline of stroke mortality in rural areas. There is a need to better understand the contributors to these temporal changes; however, a general lack of temporal data on potential contributors prevents this investigation. However considering contributors to the rural-urban differences pooled across time, an overall a higher stroke incidence in rural areas appears to be a contributor to the higher rural stroke mortality, with this higher incidence potentially associated with a higher prevalence of stroke risk factors in rural areas. Conversely, studies assessing rural-urban disparities in stroke case fatality show smaller and inconsistent associations. To the extent that disparities in case fatality do exist, there are many studies showing rural-urban disparities in stroke care could be contributing. While these data offer insights to the overall rural-urban disparities in stroke mortality, additional data are needed to help understand temporal changes in the magnitude of the rural-urban stroke mortality disparity.

Abstract 192: Gender and Racial Disparities in Secondary Prevention of Stroke

Introduction: In the US, 795 000 people suffer a stroke and 133 000 die from it annually. Among the survivors, 185 000 get a recurrent stroke. There are gender and racial disparities in stroke mortality and there is need to understand the associated factors, if the AHA’s 2020 impact goal is to be achieved. The objective of this study was to assess the gender and racial differences in the use of secondary preventive measures in patients with stroke, and to identify the associated factors. Methods: This is an analysis of the 2015 Behavioral Risk Factor Surveillance System, a chronic disease survey conducted by the CDC. The sample included 18 269 subjects with stroke. outcomes analyzed included: exercise, diet, smoking cessation, alcohol intake, body mass index, use of blood pressure (BP) medications and the use of aspirin. Gender and racial disparities were analyzed using logistic regression analysis. Age, race, education and income were adjusted for in the outcomes. Results: Women comprised 58.3% of the stroke cohort. White, black and Hispanic respondents represented 75.1%, 11.5% and 4.7% respectively. The mean ages of study subjects were 66.6 and 67 years for men and women respectively. Women were more likely to continue smoking (OR 1.22 (1.13, 1.32)), less likely to meet both the AHA exercise guidelines (OR 0.87 (0.81, 0.94)) and more likely to be obese/overweight (OR 1.45 (1.35, 1.54)). They were also less likely to be on aspirin (OR 0.57 (0.40, 0.80)) and BP medications (OR 0.96 (0.85, 1.09)). Women were more likely to eat ≥1 servings of fruits (OR 1.41 (1.33, 1.50)) and vegetables (OR 1.32 (1.23, 1.40)), were more likely to have health insurance (OR 1.21 (1.04, 1.40)) and clinical provider (OR 1.76 (1.75, 1.76)). Hispanics were more likely to continue smoking compared with whites (OR 1.37 (1.15, 1.63), Blacks and Hispanics were less likely to exercise compared with whites (OR 0.66 (0.61, 0.72) and (OR 0.78 (0.68, 0.88) respectively. Blacks were less likely to eat fruits (OR 0.7 (0.64, 0.76) and vegetables (OR 0.56 (0.51, 0.61) but these effects were attenuated by adjusting for income and education. Conclusion: There are significant gender and racial disparities in secondary stroke preventive measures. Income and education may play an important role in the disparity.

Abstract WMP57: Geographic Disparities in Stroke and Life Expectancy Significantly Attributable to Ambient PM2.5 Pollution Across the Counties of the United States

Background: We aimed to test the hypotheses that ambient particulate matter (PM2.5) is significantly associated with the risk of stroke mortality and life expectancy (LE) reduction, and the degrees of these associations differ across the counties and regions of the United States (U.S). Methods: Annual average county-level data (n=1561 counties) from U.S. Centers for Disease Control and Prevention, and Environmental Protection Agency on PM2.5 measures in 2005-2010, age-adjusted stroke mortality in adults aged ≥35 in 2013-2015, and LE in 2010, as well as % of poverty rate, number of primary care physicians per 1000 residents (as a marker of healthcare support) and county-level % of rural population as covariates were analyzed using linear and multilevel hierarchical regression analyses. Results: Significant county-level variations in annual average PM2.5 levels (range: 7.2-14.7 ug/ 3 ), stroke mortality (30.1-219.0 per 100,000 population in males, and 35.0-249.0 in females), and LE (65.0-81.7 years in males and 72.7-85.0 in females) were observed across the nation. Population-weighted PM2.5 levels were significantly and positively associated with stroke mortality in males (r=0.49, p&lt;.0001), and in females (r=0.42, p&lt;.0001), and negatively associated with LE in males (r=-0.39, p&lt;.0001) and females (r=-0.37, p&lt;.0001). Adjusted multilevel analysis indicates that PM2.5 was significantly associated with stroke mortality rates (β=1.27, p&lt;.0001) in both sexes, and with LE in males (β=-0.18, p=&lt;.001), and in females (β=-0.09, p&lt;.001). The adverse impacts of PM2.5 were even worse in counties with higher % of poverty rates and poorer healthcare support compared to their counterparts. Analyses by regions indicate that the highest risk of PM2.5 for stroke (assessed by regression coefficients) was shown for males and females living in the South, followed by Midwest, Northeast, and West. Similar results of the risk of PM2.5 for LE reduction were observed across the regions. Conclusion: The study, using U.S. national representative datasets provides new and important evidence that geographic disparities in stroke mortality and LE are significantly attributable to ambient PM2.5 pollution across the nation.

Association between trace elements in the environment and stroke risk: The reasons for geographic and racial differences in stroke (REGARDS) study

The disparities in stroke mortality between blacks and whites, as well as the increased stroke mortality in the “stroke belt” have long been noted. The reasons for these disparities have yet to be fully explained. The association between trace element status and cardiovascular diseases, including stroke, has been suggested as a possible contributor to the disparities in stroke mortality but has not been fully explored. The purpose of this study is to investigate distributions of four trace elements (arsenic, mercury, magnesium, and selenium) in the environment in relation to stroke risk. The study population (N = 27,770) is drawn from the Reasons for Geographic and Racial Disparities in Stroke (REGARDS) cohort. Environmental distribution of each trace element was determined using data from the United States Geological Survey (USGS) and was categorized in quartiles. A proportional hazards model, adjusted for demographic data and stroke risk factors, was used to examine the association of interest. The results showed that higher selenium levels in the environment were associated with increased stroke risk, and the hazard ratio for the 4th quartile compared to the 1st quartile was 1.33 (95% CI: 1.09, 1.62). However, there was no statistically significant relationship between environmental arsenic, mercury or magnesium and the risk of stroke. Because of dietary and non-dietary exposure as well as bioavailability, further research using biomarkers is warranted to examine the association between these trace elements and the risk of stroke.

Abstract 52: Contributors to the Rural Excess in Stroke Mortality: The REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction: One NIH goal is to investigate the US nationwide rural-urban health disparities; however, few studies provide data to help understand the 30% higher rural stroke mortality. It is unknown if the higher stroke mortality is attributable to a higher incidence of stroke, or to a higher case fatality, in rural regions. Further, the role of risk factors or SES status in higher incidence or case-fatality is unknown. Methods: REGARDS participants stroke-free at baseline (n = 25,090) were stratified by Rural-Urban Commuting Area strata: urban, large rural city/town, or small rural town or isolated region. Participants were followed for incident stroke, and case fatality was defined as death within 30-days of a stroke. Difference in incident stroke was assessed using proportional hazards analysis, and case-fatality by logistic regression, each considered after adjustment for demographic factors, further adjustment for risk factors, and further adjustment for SES. Results: Over an average follow-up of 8.2 years, 1,060 incident strokes occurred, of which 160 died within 30 days. Risk of incident stroke increased with rurality (p = 0.016), with a hazard 1.21-times (95% CI: 1.00 - 1.46) higher in large rural cities/towns, and 1.24-times (95% CI: 1.00 - 1.54) higher in small rural towns or isolated regions (see table). Adjustment for risk factors and SES attenuated the estimated risk by 50%, and the association became non-significant. There was no evidence of a higher case-fatality from stroke in rural regions (p &gt; 0.46). Discussion: The higher stroke mortality in rural regions appears to be attributable to higher stroke incidence, and not to higher case-fatality. Higher stroke incidence in rural regions is partially attributable to a worse risk factor profile and lower SES. Efforts to reduce rural disparity in stroke mortality should focus on preventive strategies, especially those relevant to risk factor development and control, and/or mitigating the impact of lower SES.

Incidence and Case Fatality at the County Level as Contributors to Geographic Disparities in Stroke Mortality

Background: Is the high stroke mortality in the Southeastern parts of the United States driven by differences in stroke incidence or case-fatality? This question remains unanswered. Differences in incidence would underscore the need for stroke prevention, while differences in case fatality would call for improved stroke care. Methods: Quartiles of US counties were defined by stroke mortality, and this gradient was related with stroke incidence and stroke case fatality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, where 1,317 incident stroke events (of which 242 were fatal) occurred among 29,650 participants. Results: There was a significant (p = 0.0025) gradient of fatal stroke events in REGARDS (quartile 4 vs. quartile 1 (Q4/Q1) hazard ratio 1.95, 95% CI 1.35-2.81), demonstrating the consistency of REGARDS with national mortality data. The gradient for incident stroke (fatal + nonfatal) was also significant (p = 0.0023; Q4/Q1 hazard ratio 1.29, 95% CI 1.10-1.52). The gradient for stroke case-fatality was marginally significant (p = 0.058), though the OR for Q4/Q1 (1.71, 95% CI 1.13-2.25) was large. Conclusions: Both stroke incidence and case-fatality in REGARDS appear to be contributing, underscoring the need for strengthening both stroke prevention and acute stroke care in order to reduce the disparity.

Where to Focus Efforts to Reduce the Black-White Disparity in Stroke Mortality: Incidence Versus Case Fatality?

At age 45 years, blacks have a stroke mortality ≈3× greater than their white counterparts, with a declining disparity at older ages. We assess whether this black-white disparity in stroke mortality is attributable to a black-white disparity in stroke incidence versus a disparity in case fatality. We first assess if black-white differences in stroke mortality within 29 681 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort reflect national black-white differences in stroke mortality and then assess the degree to which black-white differences in stroke incidence or 30-day case fatality after stroke contribute to the disparities in stroke mortality. The pattern of stroke mortality within the study mirrors the national pattern, with the black-to-white hazard ratio of ≈4.0 at age 45 years decreasing to ≈1.0 at age 85 years. The pattern of black-to-white disparities in stroke incidence shows a similar pattern but no evidence of a corresponding disparity in stroke case fatality. These findings show that the black-white differences in stroke mortality are largely driven by differences in stroke incidence, with case fatality playing at most a minor role. Therefore, to reduce the black-white disparity in stroke mortality, interventions need to focus on prevention of stroke in blacks.

Abstract 84: Where Should Interventions be Focused to Reduce the Black-white Disparity in Stroke Mortality? Insights From the Reasons For Geographic And Racial Differences In Stroke (REGARDS) Study

Introduction: The study of racial disparities in stroke mortality should guide interventions to reduce these disparities. A higher mortality in blacks than whites could result from a higher incidence of stroke in blacks, a higher case-fatality of stroke in blacks, or both. Interventions focusing on primary prevention are needed if incidence is a major contributor to disparities, while interventions addressing treatment are a priority if case-fatality is a major contributor. Hypothesis: Higher stroke mortality in REGARDS will be attributable to higher incidence, higher case fatality, or both. Methods: 29,681 black and white participants aged 45+ were followed for stroke over 7 years. Fatal stroke (stroke mortality) was defined as a stroke event with death within 30-days, incident stroke included all stroke events (regardless of death), and case-fatality as the proportion of stroke events with death within 30-days. Black-white differences in stroke mortality and stroke incidence were assessed using proportional hazards models, and case-fatality using logistic regression (with adjustment for age and sex). Results: There were 954 incident events with 242 deaths within 30-days. We showed higher stroke mortality in blacks, with a black-white disparity in fatal stroke at young ages (at age 45, HR = 4.35; 95% CI: 1.94-9.76), but a declining magnitude of the disparity at older ages (at age 85, HR = 0.87; 95% CI: 0.56 - 1.35). The pattern was similar for incident stroke, although the magnitude of the black-white disparity was smaller (at age 45: HR = 2.40; 95% CI: 1.72 - 3.33; at age 85: HR = 0.95; 95% CI: 0.76 - 1.19). There was no evidence of a black-white disparity in case-fatality rate (OR = 1.26; 95% CI: 0.93 - 1.71). Conclusion: In a nationwide cohort, we found that the black-white disparity in stroke mortality was primarily attributable to a racial disparity in stroke incidence, not case fatality. Thus, interventions designed to reduce the black-white disparity in stroke mortality require a primary prevention focus aimed at reducing the disparity in stroke incidence. While effective interventions to improve stroke outcomes are needed, these data suggest that improving treatment after the initial event will not reduce black-white disparities in stroke mortality.

Acute infection contributes to racial disparities in stroke mortality

It is unknown whether racial differences in exposure to acute precipitants of stroke, specifically infection, contribute to racial disparities in stroke mortality. Among participants in the nationally representative Health and Retirement Study with linked Medicare data (1991-2007), we conducted a case-crossover study employing within-person comparisons to study racial/ethnic differences in the risks of death and hospitalization from ischemic stroke following acute infection. There were 964 adults hospitalized for ischemic stroke. Acute infection increased the 30-day risks of ischemic stroke death (5.82-fold) and ischemic stroke hospitalization (1.87-fold). Acute infection was a more potent trigger of acute ischemic stroke death in non-Hispanic blacks (odds ratio [OR] 39.21; 95% confidence interval [CI] 9.26-166.00) than in non-Hispanic whites (OR 4.50; 95% CI 3.14-6.44) or Hispanics (OR 5.18; 95% CI 1.34-19.95) (race-by-stroke interaction, p = 0.005). When adjusted for atrial fibrillation, infection remained more strongly associated with stroke mortality in blacks (OR 34.85) than in whites (OR 3.58) and Hispanics (OR 3.53). Acute infection increased the short-term risk of incident stroke similarly across racial/ethnic groups. Infection occurred often before stroke death in non-Hispanic blacks, with 70% experiencing an infection in the 30 days before stroke death compared to a background frequency of 15%. Acute infection disproportionately increases the risk of stroke death for non-Hispanic blacks, independently of atrial fibrillation. Stroke incidence did not explain this finding. Acute infection appears to be one factor that contributes to the black-white disparity in stroke mortality.

The Neighborhood Where You Live Is a Risk Factor for Stroke

The excess stroke mortality in the southeastern states of the United States (stroke-belt states) is well known; however, the factors associated with this pattern have not been fully elucidated. We measured the contribution of several demographic factors by analyzing stroke mortality data (2005-2009) at the census block group (BG) level in the state of Arkansas. Census BGs were used as proxies for neighborhoods. BGs were stratified using 5 census measures: poverty (percent of population below federal poverty level), population density (population per square mile), education (percent of population aged >25 years who did not graduate from high school), population mobility (percent of population who resided at the same address 1 year ago), and the percent of non-Hispanic blacks (percent of population that is black). Generalized additive models were used to estimate the variation in stroke mortality among BGs and to assess the impact of different demographic variables. From 2005 to 2009, there were 8930 stroke deaths in Arkansas. There was considerable variation in the relative risk even between adjacent BGs within a single county. The geographically weighted regression analyses indicated that 4.5% to 9% of deviance in stroke mortality among BGs could be explained by poverty, education, population density, and population mobility. Race/ethnicity (non-Hispanic blacks) explains <2% of the deviance in stroke mortality among BGs. Our study shows that primordial risk factors such as poverty and education drive disparities in stroke mortality among neighborhoods in Arkansas.

Ancel Keys Lecture

One of the 2 key goals of the Healthy People 2010 statement, the guiding document for the United States Department of Health and Human Services, is to “eliminate health disparities among different segments of the population” by the year 2010.1 The US Congress has by law directed National Institutes of Health (NIH) to specifically define health disparities to include the components: For brevity, we focus on a review of the magnitude of the disparities in stroke of only the first 2 of these disparities: review progress in reducing these disparities, and assess barriers and opportunities to reduce these disparities. Racial differences in stroke mortality are the most well-known and well documented of the stroke disparities.3–5 Among non-Hispanics aged between 45 and 64 years, in 2009, there were 4359 deaths from stroke and an age-adjusted death rate of 48.9 per 100 000 in blacks, whereas there were 9994 deaths and a death rate of 16.3 per 100 000 in whites; this represents a 3-fold difference in death rates.6 There would have been ≈3000 fewer deaths for blacks in this 20-year age range if they had the mortality rate of whites (4359×(16.3/48.9)=1424 projected deaths for a reduction of 2935 deaths). If the case-fatality rate is 20%, then these 3000 deaths would have arisen from ≈15 000 extra stroke events (3000/0.2=15 000), and a public health burden of the racial disparity in stroke is ≈$2.1 billion dollars annually (assuming a $140 000 cost of stroke).7 The racial disparity in stroke mortality has been remarkably persistent, where between 1949 and 1951 the nonwhite (primarily blacks)/white stroke mortality ratio was 1.63 for men …

Racial Disparities in Stroke Mortality in the United States 2000-2009 (P05.212)

Racial Disparities in Stroke Mortality in the United States 2000-2009 (P05.212)

Abstract WP374: Racial Disparities in Stroke Mortality in the United States 2000-2009

OBJECTIVES: To test the hypothesis that the racial disparities in stroke mortality have declined in the last decade due to increased awareness and recognition. DESIGN: Analysis of the U.S. multiple-cause-of-death files for 2000 to 2009. PARTICIPANTS: Decedents with stroke (defined by ICD-10 code I60-I64) as underlying cause of death on the death certificate. MEASUREMENTS: Age-adjusted fatal stroke incidence for whites, African Americans, American Indians, and Asian and Pacific Islanders aged 25 and older based on the U.S. Census of 2000. The stroke rate ratio with 95% confidence interval (CI) and average annual percentage change over 10 years was also calculated. RESULTS: From 2000-2009, the U.S. age-adjusted annual death rate per 100,000 for stroke was 242 in African Americans and 199 in whites. The difference between rates in African Americans and whites ranged from 2 excessive deaths per 100,000 in persons aged 25-34 years to 82 excessive deaths per 100,000 in persons aged 75-84 years. Compared with whites, the stroke rate ratio was 1.2(95% CI 1.0-1.3) for African Americans, 0.6(95% CI 0.5-0.8) for American Indians, and 0.8(95% CI 0.7-1.0) for Asian and Pacific Islanders. The average annual percentage change over 10 years was -6.1%, -5.3%, -5.2%, and -4.6% Asian and Pacific Islanders, American Indians, whites, and African Americans, respectively. CONCLUSION: There has been a similar reduction in stroke related mortality among all racial groups between 2000 and 2009. However, the excessive stroke mortality among African Americans continues and is unlikely to change without primary and secondary preventive strategies targeted towards African Americans.

Abstract WP200: Racial Disparities In Stroke Mortality In Brazil

Background: Racial disparities in stroke mortality are well known, but most of the studies were performed in United States. We aimed to analyze stroke mortality rates in Brazil that has a racial distribution including white, brown, and black people. Methods: Mortality data were obtained from the official statistics health bureau. All deaths were classified according to the 10th revision of International Classification of Diseases (ICD10). Data about stroke (ICD10:I60-69), acute stroke (ICD10:I60-68), sequels of stroke (ICD10:I69), ischemic stroke (ICD10:I63-64), intracerebral hemorrhage (ICD10:I61-62, cardiovascular disease (ICD10: Chapter I) and hypertension (ICD10:I10-15) in the years of 2010 was analyzed according to gender and age-strata. Population was based on the National Census Data (2010). Results: There is a consistent gradient of stroke mortality rates with higher risk of stroke deaths in black, an intermediate in brown and a lower risk in white in all categories except for sequels of stroke, and for both gender. Conclusion: mortality rates associated to stroke and its subtypes is race dependent with the burden concentrated in black and brown people. Hypertension plays a very influential role in this scenario