title: One-year disability, death and recurrence after first-ever stroke in a Black Afro-Caribbean population.
abstract: Background Few data on stroke outcomes and no data on stroke recurrence are available in Black mono-racial population with high socio-economic status. Aims We investigated outcomes and stroke recurrence at one year in the Black Afro-Caribbean population of Martinique and examined potential predictors of poor prognosis and recurrence. Methods Patients from ERMANCIA II (Etude Réalisée en MArtinique et Centrée sur l'Incidence des Accidents vasculaires cérébraux), a Black population-based and prospective observational study, were followed up at 28-days, three months and one year post stroke. Stroke characteristics, survival, disability (modified Rankin Scale > 2), and stroke recurrence were assessed. A survival-based approach was used for time-to-event analysis, and multivariable regression analysis assessed the predictors of death, disability and stroke recurrence. Results Of 544 first-ever stroke patients, cumulative risks of death increased from 17.6% (95% confidence interval, 14.5-20.4) at 28 days to 22.8% (18.6-25.0) at three months and to 31.3% (27.4-34.6) at one year. Disability rates in survivors decreased from 43.7% (39.5-47.2) at 28 days to 35% (30.9-38.4) at three months and to 28.8% (24.9-32.1) at one year. Cumulative risks of recurrent stroke were estimated to 2.1% (0.9-2.9) at 28 days, 4.5% (2.7-6.1) at three months and 9.3% (6.1-11.6) at one year. Age (odds ratio (OR), 1.08 (1.05-1.10)), admission NIHSS (OR, 1.22 (1.17-1.29)), metabolic syndrome (OR, 2.07 (1.22-3.52)) and recurrence (OR, 5.06 (1.87-13.7)) were independent predictors of death or disability at one year. Conclusion Stroke Outcomes in Black Afro-Caribbean population with a high socio-economic status appear globally similar to outcomes reported in Caucasian population. After a first-ever stroke, the implementation of early programs of recurrence prevention seems crucial to reduce the risk of poor prognosis at one year.
authors.affiliation: 1 Stroke Unit, University Hospital of Bordeaux, Bordeaux, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Olindo
authors.affiliation: 2 Stroke Unit, University Hospital of Martinique, Fort de France, Martinique FWI, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Saint-Vil
authors.affiliation: 2 Stroke Unit, University Hospital of Martinique, Fort de France, Martinique FWI, France.
authors.forename: Severine
authors.initials: S
authors.lastname: Jeannin
authors.affiliation: 2 Stroke Unit, University Hospital of Martinique, Fort de France, Martinique FWI, France.
authors.forename: Aissatou
authors.initials: A
authors.lastname: Signate
authors.affiliation: 2 Stroke Unit, University Hospital of Martinique, Fort de France, Martinique FWI, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Edimonana-Kaptue
authors.affiliation: 2 Stroke Unit, University Hospital of Martinique, Fort de France, Martinique FWI, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cabre
authors.affiliation: 3 Stroke Unit, Hospital Sud Francilien, Corbeil-Essonnes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chausson
authors.affiliation: 3 Stroke Unit, Hospital Sud Francilien, Corbeil-Essonnes, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Smadja
authors.affiliation: 2 Stroke Unit, University Hospital of Martinique, Fort de France, Martinique FWI, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Joux
mesh_terms: D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008395:Martinique / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology*
keywords: African; epidemiology; outcomes; recurrent stroke; risk factors; stroke