Study: African-Americans Live Longer After Stroke
Survival May Not Predict Quality of Care, Researchers Say
Jan. 31, 2011 -- New research suggests that African-Americans have a better survival rate than whites after hospitalization for stroke, but the study raises more questions than it answers about the impact of treatment decisions on outcomes and the meaning of stroke mortality statistics, investigators say.
Using data from a statewide hospital registry, researchers examined survival among all stroke patients treated in New York state in 2005 and 2006.
In addition to living longer, African-American patients were less likely than whites to receive clot-busting drugs but more likely to receive treatments considered to be end-of-life interventions, such as cardiopulmonary resuscitation or kidney dialysis.
They were also less likely to be discharged to hospice care following treatment.
Since the registry did not include information on stroke severity or post-stroke quality of life, it is possible that longer survival did not mean better outcomes for the patients in the study, lead author Ying Xian, MD, tells WebMD.
The study was published today in the Annals of Internal Medicine.
“Mortality is an important measure of quality of care, but it is not the only measure,” he says. “A patient’s neurological status, disability, and quality of life have to also be considered.”
Stroke Survival Better for African-Americans
African-Americans are more likely to suffer strokes than whites, and studies suggest that they have less access to state-of-the-art stroke treatments.
It would stand to reason that their short-term survival following hospitalization for stroke would be worse, but that is not what this study and several others have found, University of Rochester neurologist Robert Holloway, MD, MPH, tells WebMD.
“Ours is not the first study to show that after admission to the hospital, survival among black and white stroke patients may differ in ways that are unexpected,” he says.
Holloway, Xian, and colleagues examined outcomes over the course of a year among 5,219 African-American and 18,340 white stroke patients treated at 164 hospitals in New York state.
Among the major findings:
- The death rate during hospitalization for stroke was 5% among African-American patients and 7.4% among whites.
- The death rate one month after a stroke was 6.1% among African-American patients and 11.4% among whites.
- The death rate at one year after a stroke was 16.5% among African-American patients and 24.4% among whites.
- Whites were less likely than blacks to receive life-sustaining interventions like intubation, cardiopulmonary resuscitation, and tracheostomy.
It has been suggested that blacks have a higher incidence than whites of strokes caused by small vessel disease. These strokes tend to be less deadly than those affecting the large vessels that supply oxygen to the brain, but Holloway and Xian do not believe this fully explains the mortality difference seen in their study.