title: Racial/Ethnic differences in process of care and outcomes among patients hospitalized with intracerebral hemorrhage.
abstract: OBJECTIVE
  Although racial/ethnic differences in care are pervasive in many areas of medicine, little is known whether intracerebral hemorrhage (ICH) care processes or outcomes differ by race/ethnicity.
  
  
  METHODS
  We analyzed 123 623 patients with ICH (83 216 white, 22 147 black, 10 519 Hispanic, and 7741 Asian) hospitalized at 1199 Get With The Guidelines-Stroke hospitals between 2003 and 2012. Multivariable logistic regression with generalized estimating equation was used to evaluate the association among race, stroke performance measures, and in-hospital outcomes.
  
  
  RESULTS
  Relative to white patients, black, Hispanic, and Asian patients were significantly younger, but more frequently had more severe stroke (median National Institutes of Health Stroke Scale, 9, 10, 10, and 11, respectively; P<0.001). After adjustment for both patient and hospital-level characteristics, black patients were more likely to receive deep venous thrombosis prophylaxis, rehabilitation assessment, dysphagia screening, and stroke education, but less likely to have door to computed tomographic time ≤25 minutes and smoking cessation counseling than whites. Both Hispanic and Asian patients had higher odds of dysphagia screening but lower odds of smoking cessation counseling. In-hospital all-cause mortality was lower for blacks (23.0%), Hispanics (22.8%), and Asians (25.3%) than for white patients (27.6%). After risk adjustment, all minority groups had lower odds of death, of receiving comfort measures only or of being discharged to hospice. In contrast, they were more likely to exceed the median length of stay when compared with white patients.
  
  
  CONCLUSIONS
  Although individual quality indicators in ICH varied by race/ethnicity, black, Hispanic, and Asian patients with ICH had lower risk-adjusted in-hospital mortality than white patients with ICH.
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.). ying.xian@duke.edu.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holloway
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Mathew J
authors.initials: MJ
authors.lastname: Reeves
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Margueritte
authors.initials: M
authors.lastname: Cox
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: DaiWai M
authors.initials: DM
authors.lastname: Olson
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Lytle
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: From the Duke Clinical Research Institute, Durham, NC (Y.X., P.J.S., M.C., A.F.H., B.L.L., E.D.P.); Department of Neurology, University of Rochester Medical Center, NY (R.G.H.); Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (E.E.S.); Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.); Department of Epidemiology, Michigan State University, East Lansing (M.J.R.); Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.); Neurology & Neurotherapeutics, Neurological Surgery, University of Texas Southwestern Medical Center, Dallas (D.M.O.); and Division of Cardiology, University of California, Los Angeles (G.C.F.).
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy*; D015331:Cohort Studies; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000208:ethnology*; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
keywords: cerebral hemorrhage; continental population groups; ethnology; outcomes research; quality of health care