title: Racial and ethnic differences in outcomes in older patients with acute ischemic stroke.
abstract: BACKGROUND
  Little is known as to whether long-term outcomes of acute ischemic stroke (AIS) vary by race/ethnicity. Using the American Heart Association Get With The Guidelines-Stroke registry linked with Medicare claims data set, we examined whether 30-day and 1-year outcomes differed by race/ethnicity among older patients with AIS.
  
  
  RESULTS
  We analyzed 200 900 patients with AIS >65 years of age (170 694 non-Hispanic whites, 85.0%; 20 514 non-Hispanic blacks, 10.2%; 6632 Hispanics, 3.3%; 3060 non-Hispanic Asian Americans, 1.5%) from 926 US centers participating in the Get With The Guidelines-Stroke program from April 2003 through December 2008. Compared with whites, other racial and ethnic groups were on average younger and had a higher median score on the National Institutes of Health Stroke Scale. Whites had higher 30-day unadjusted mortality than other groups (white versus black versus Hispanic versus Asian=15.0% versus 9.9% versus 11.9% versus 11.1%, respectively). Whites also had higher 1-year unadjusted mortality (31.7% versus 28.6% versus 28.1% versus 23.9%, respectively) but lower 1-year unadjusted all-cause rehospitalization (54.7% versus 62.5% versus 60.0% versus 48.6%, respectively). After risk adjustment, Asian American patients with AIS had lower 30-day and 1-year mortality than white, black, and Hispanic patients. Relative to whites, black and Hispanic patients had higher adjusted 1-year all-cause rehospitalization (black: adjusted odds ratio, 1.28 [95% confidence interval, 1.21-1.37]; Hispanic: adjusted odds ratio, 1.22 [95% confidence interval, 1.11-1.35]), whereas Asian patients had lower odds (adjusted odds ratio, 0.83 [95% confidence interval, 0.74-0.94]).
  
  
  CONCLUSIONS
  Among older Medicare beneficiaries with AIS, there were significant differences in long-term outcomes by race/ethnicity, even after adjustment for stroke severity, other prognostic variables, and hospital characteristics.
authors.affiliation: Department of Health Policy, Management & Behavior, School of Public Health,University at Albany-State University of New York, Albany, NY 12144, USA. fqian@albany.edu.
authors.forename: Feng
authors.initials: F
authors.lastname: Qian
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.forename: Wenqin
authors.initials: W
authors.lastname: Pan
authors.forename: Edward L
authors.initials: EL
authors.lastname: Hannan
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Shaw
authors.forename: Laurent G
authors.initials: LG
authors.lastname: Glance
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Zubin J
authors.initials: ZJ
authors.lastname: Eapen
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D044469:Racial Groups / Q000706:statistics & numerical data*; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: disparities; outcome; race and ethnicity; stroke