Poor outcomes in Hispanic and African American patients after acute ischemic stroke: influence of diabetes and hyperglycemia.
BACKGROUND
Stroke is a leading cause of mortality and disability in the United States, and it disproportionately affects vulnerable populations, such as Hispanics and African Americans. We compared the prevalence of stroke risk factors, in-hospital treatment of hyperglycemia, and outcome among different ethnic groups after acute ischemic stroke (AIS).


METHODS
Retrospective study of patients with AIS treated at an urban tertiary care center. Hispanic, African American, and White patients were compared by demography, illness severity, co-morbid conditions, degree of treatment of hyperglycemia, and outcome. Data were analyzed by using t testing, chi2 testing, and analyses of variance, as appropriate.


RESULTS
960 cases were reviewed (68% African American, 13% Hispanic, 11% White, 8% other). Hispanic and African American patients were younger than White patients. More White patients had atrial fibrillation (26.7%) than did Hispanic (9.5%) or African American patients (6.6%, P<.001). Hispanic and African American patients had higher rates of hypertension (76%, 77%) than did White patients (55%, P<.001), and more Hispanic patients had diabetes (58%) than did either African American (37%) or White patients (27%, P<.001). Hispanic patients had higher blood glucose levels than did African American or White patients at baseline, 24 hours, and 48 hours after admission (P<.05). Diabetic Hispanic patients had higher in-hospital mortality rates (8.0%) than did diabetic non-Hispanic patients (2.5%, P=.03).


CONCLUSIONS
The incidence of stroke risk factors (atrial fibrillation, diabetes mellitus, and hypertension) differs between urban African American, Hispanic, and White patients. Hyperglycemia, a known independent predictor of mortality after stroke, is more likely to be present and persist during hospitalization in Hispanic patients than in African American and White patients. These disparities may explain the disproportionate mortality rates among Hispanic and African American and White patients after AIS. Focusing prevention and treatment towards hypertension, diabetes, and hyperglycemia may reduce racial/ethnic disparities and improve mortality and disability after acute ischemic stroke.
Gentile
Nina T
NT
Department of Emergency Medicine, Temple University Hospital and School of Medicine, Philadelphia, PA 19122, USA. ngentile@temple.edu
Seftchick
Michael W
MW
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000208:ethnology* / Q000628:therapy; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000208:ethnology* / Q000628:therapy; D006973:Hypertension / Q000150:complications / Q000208:ethnology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D016896:Treatment Outcome