Racial disparities in the development of dysphagia after stroke: analysis of the California (MIRCal) and New York (SPARCS) inpatient databases.
OBJECTIVE
To determine whether the proportion of patients with stroke experiencing dysphagia differs among racial groups and whether this relation can be explained by stroke type or severity.


METHODS
Case-control study using California's Medical Information Reporting and New York's Statewide Planning and Research Cooperative System databases for 2002. Cases had primary diagnosis of cerebrovascular disease (International Classification of Disease, 9th Revision [ICD-9] codes 430-438.9, excluding transient [435-435.9] and late-effects [438-438.9]), and self-identified race was white, black, or Asian. Two comparison groups were selected: (1) Parkinson's disease (ICD-9 codes 332-332.1) and (2) oral cancer (ICD-9 codes 141-149).


METHODS
Inpatient admissions in the respective states.


METHODS
Cases with primary diagnosis of cerebrovascular disease whose self-identified race was white, black, or Asian.


METHODS
Not applicable.


METHODS
Dysphagia, defined by ICD-9 codes 787.2 (dysphagia), 507.0 (aspiration pneumonia), or presence of a feeding tube in the absence of a diagnosis of coma (Current Procedural Terminology codes 432.46 or 437.50 without ICD-9 code 780.01).


RESULTS
In the stroke group, the adjusted odds ratio (OR) with 95% confidence interval (CI) for dysphagia was significantly higher for Asians than whites in New York (OR=1.64; 95% CI, 1.50-1.79) and California (OR=1.69; 95% CI, 1.34-2.13). The adjusted OR was slightly but significantly higher for blacks than whites in New York (OR=1.15; 95% CI, 1.03-1.28), but not in California (OR=1.08; 95% CI, 0.97-1.19). No statistically significant differences among racial groups were found in patients with Parkinson's disease or oral cancer. Other factors strongly associated with dysphagia included hemiplegia (OR=2.19; 95% CI, 2.07-2.32) and aphasia (OR=1.97; 95% CI, 1.83-2.11).


CONCLUSIONS
Asians were more likely to have dysphagia after stroke. This association was statistically significant after adjusting for age, sex, stroke severity indicators, comorbidities, and stroke type.
Gonzalez-Fernandez
Marlis
M
Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. Mgonzal5@jhmi.edu
Kuhlemeier
Keith V
KV
Palmer
Jeffrey B
JB
D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D002140:California; D016022:Case-Control Studies; D003680:Deglutition Disorders / Q000208:ethnology* / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D016017:Odds Ratio; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000208:ethnology*