Mortality and causes of death after first ischemic stroke: the Northern Manhattan Stroke Study.
OBJECTIVE
To analyze the early and long-term causes of death after first ischemic stroke in the multiethnic northern Manhattan community.


METHODS
In the prospective, population-based Northern Manhattan Stroke Study, 980 patients with first ischemic stroke (mean age 70 years; 56% women; 49% Caribbean Hispanic, 31% black, 20% white) were followed for a mean of 3 years. Causes of death were classified as vascular (incident stroke, recurrent stroke, cardiac) or nonvascular. Life table analyses were used to assess mortality risks among different race-ethnic groups. Early (< or =1 month) vs long-term (> 1 month to 5 years) causes of death were compared.


RESULTS
Among the 980 patients followed, 278 (28%) died; 47 (5%) died during the first month. Cumulative mortality risk was 5% at 1 month, 16% after 1 year, 29% after 3 years, and 41% after 5 years. The proportion of vascular deaths among all deaths was 75% at 1 month and 43% thereafter (p = 0.001). Stroke, either incident (53%) or recurrent (4%), caused early deaths in 57% and long-term deaths in 14% (p = 0.001). Overall mortality risks did not differ significantly among race-ethnic groups. However, the proportion of incident stroke-related early deaths was 85% in Caribbean Hispanic patients, 33% in white patients, and 25% in black patients (p = 0.002).


CONCLUSIONS
Among patients with first ischemic stroke, incident stroke is the leading cause of early deaths. A large proportion of long-term deaths are nonvascular in origin. Despite similar overall mortality rates in race-ethnic groups, our data suggest a higher incident stroke-related early mortality among Caribbean Hispanics.
Hartmann
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Stroke Center, Department of Neurology, Columbia University College of Physicians and Surgeons and School of Public Health, New York, NY, USA. ahart@zedat.fu-berlin.de
Rundek
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Mast
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Paik
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Boden-Albala
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Mohr
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Sacco
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D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D002423:Cause of Death; D002544:Cerebral Infarction / Q000208:ethnology / Q000401:mortality*; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011446:Prospective Studies; D016019:Survival Analysis; D014505:Urban Population / Q000706:statistics & numerical data*; D044465:White People; D001741:Black or African American