African American women have poor long-term survival following ischemic stroke.
OBJECTIVE
To determine racial and gender differences in long-term survival following ischemic stroke in a well-defined cohort of patients.


METHODS
We analyzed the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. We determined the effect of race and gender on 1-year survival ascertained by serial follow-ups using Kaplan-Meier analysis. Multivariate analysis was performed adjusting for age, initial NIH Stroke Scale (NIHSS) score, use of thrombolysis, time to randomization, stroke etiology, and other cardiovascular risk factors.


RESULTS
Of the 547 patients with ischemic stroke, the 1-year survival (percentage +/- SE) for African American women (63 +/- 6%) was lower than white women (73 +/- 4%), African American men (79 +/- 4%), and white men (75 +/- 3%). Among the 209 patients younger than 65 years, the 1-year survival was prominently lower for African American women (66 +/- 8%) vs white women (87 +/- 5%), African American men (83 +/- 5%), and white men (89 +/- 3%). In the Cox proportional hazard analysis, African American women had a significantly higher rate of 1-year mortality (relative risk 2.1, 95% CI 1.2 to 3.5) after adjusting for all potential confounders except diabetes mellitus. After adjustment for diabetes mellitus, the difference became insignificant, although a 70% greater risk of 1-year mortality was still observed.


CONCLUSIONS
Compared with whites and men, African American women have a lower 1-year survival following ischemic stroke.
Qureshi
Adnan I
AI
Epidemiological and Outcomes Research Division, Zeenat Qureshi Stroke Research Center. aiqureshi@hotmail.com
Suri
M Fareed K
MF
Zhou
Jingying
J
Divani
Afshin A
AA
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D002545:Brain Ischemia / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015990:Placebo Effect; D011446:Prospective Studies; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D015996:Survival Rate / Q000639:trends; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
D010959:Tissue Plasminogen Activator