title: Loss of the Mexican American survival advantage after ischemic stroke.
abstract: OBJECTIVE
  Mexican Americans (MAs) were previously found to have lower mortality after ischemic stroke than non-Hispanic whites. We studied mortality trends in a population-based design.
  
  
  METHODS
  Active and passive surveillance were used to find all ischemic stroke cases from January 2000 to December 2011 in Nueces County, TX. Deaths were ascertained from the Texas Department of Health through December 31, 2012. Cumulative 30-day and 1-year mortality adjusted for covariates was estimated using log-binomial models with a linear term for year of stroke onset used to model time trends. Models used data from the entire study period to estimate adjusted mortality among stroke cases in 2000 and 2011 and to calculate projected ethnic differences.
  
  
  RESULTS
  There were 1974 ischemic strokes among non-Hispanic whites and 2439 among MAs. Between 2000 and 2011, model estimated mortality declined among non-Hispanic whites at 30 days (7.6% to 5.6%; P=0.24) and 1 year (20.8% to 15.5%; P=0.02). Among MAs, 30-day model estimated mortality remained stagnant at 5.1% to 5.2% (P=0.92), and a slight decline from 17.4% to 15.3% was observed for 1-year mortality (P=0.26). Although ethnic differences in 30-day (P=0.01) and 1-year (P=0.06) mortality were apparent in 2000, they were not so in 2011 (30-day mortality, P=0.63; 1-year mortality, P=0.92).
  
  
  CONCLUSIONS
  Overall, mortality after ischemic stroke has declined in the past decade, although significant declines were only observed for non-Hispanic whites and not MAs at 1 year. The survival advantage previously documented among MAs vanished by 2011. Renewed stroke prevention and treatment efforts for MAs are needed.
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor. Lmorgens@umich.edu.
authors: Lewis B
authors: LB
authors: Morgenstern
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Devin L
authors: DL
authors: Brown
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Melinda A
authors: MA
authors: Smith
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Brisa N
authors: BN
authors: Sánchez
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Darin B
authors: DB
authors: Zahuranec
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Nelda
authors: N
authors: Garcia
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Kevin A
authors: KA
authors: Kerber
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Lesli E
authors: LE
authors: Skolarus
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: William J
authors: WJ
authors: Meurer
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: James F
authors: JF
authors: Burke
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Eric E
authors: EE
authors: Adelman
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Jonggyu
authors: J
authors: Baek
authors: From the Stroke Program (L.B.M., D.L.B., M.A.S., D.B.Z., N.G., K.A.K., L.E.S., W.J.M., J.F.B., E.E.A., L.D.L.), Emergency Medicine (L.B.M., W.J.M.), Epidemiology (L.B.M., L.D.L.), and Biostatistics (B.N.S., J.B.), University of Michigan, Ann Arbor.
authors: Lynda D
authors: LD
authors: Lisabeth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000208:ethnology* / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D011159:Population Surveillance; D020521:Stroke / Q000208:ethnology* / Q000401:mortality*; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D044465:White People
keywords: Hispanic Americans; mortality; trends