title: Racial differences in mortality among patients with acute ischemic stroke: an observational study.
abstract: BACKGROUND
  Black patients are commonly believed to have higher stroke mortality. However, several recent studies have reported better survival in black patients with stroke.
  
  
  OBJECTIVE
  To examine racial differences in stroke mortality and explore potential reasons for these differences.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  164 hospitals in New York.
  
  
  METHODS
  5319 black and 18 340 white patients aged 18 years or older who were hospitalized with acute ischemic stroke between January 2005 and December 2006.
  
  
  METHODS
  Influence of race on mortality, examined by using propensity score analysis. Secondary outcomes were selected aspects of end-of-life treatment, use of tissue plasminogen activator, hospital spending, and length of stay. Patients were followed for mortality for 1 year after admission.
  
  
  RESULTS
  Overall in-hospital mortality was lower for black patients than for white patients (5.0% vs. 7.4%; P < 0.001), as was all-cause mortality at 30 days (6.1% vs. 11.4%; P < 0.001) and 1 year (16.5% vs. 24.4%; P < 0.001). After propensity score adjustment, black race was independently associated with lower in-hospital mortality (odds ratio [OR], 0.77 [95% CI, 0.61 to 0.98]) and all-cause mortality up to 1 year (OR, 0.86 [CI, 0.77 to 0.96]). The adjusted hazard ratio was 0.87 (CI, 0.79 to 0.96). After adjustment for the probability of dying in the hospital, black patients with stroke were more likely to receive life-sustaining interventions (OR, 1.22 [CI, 1.09 to 1.38]) but less likely to be discharged to hospice (OR, 0.25 [CI, 0.14 to 0.46]).
  
  
  CONCLUSIONS
  The study used hospital administrative data that lacked a stroke severity measure. The study design precluded determination of causality.
  
  
  CONCLUSIONS
  Among patients with acute ischemic stroke, black patients had lower mortality than white patients. This could be the result of differences in receipt of life-sustaining interventions and end-of-life care.
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27701, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holloway
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.forename: Bruce
authors.initials: B
authors.lastname: Friedman
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D019370:Observation; D016017:Odds Ratio; D057216:Propensity Score; D016016:Proportional Hazards Models; D020521:Stroke / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality*; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents