Black Medicare Patients 4% More Likely to Die in Decade Following Stroke than White Counterparts

Judith Lichtman, PhD, MPH

While racial disparities in care have been a matter of discussion and action among major cardiology organizations, both in the US and abroad, new research suggests significant differences still persist in regard to the long-term risk of death following a stroke.

Presented at the International Stroke Conference (ISC) 2021, the Yale School of Medicine-led analysis of Medicare beneficiary data returned results suggesting the overall death rate was about 75%, but Black patients had a 4% higher risk of death in the 10 years following a stroke than their white counterparts.

“So much of what we know is limited to the early or acute phase — the first two weeks after a stroke,” said lead study author Judith H. Lichtman, PhD, MPH, professor and chair of the department of epidemiology at the Yale School of Public Health in New Haven, Connecticut, in a statement. “When you have a stroke, it’s not just about the acute event, it’s about the early recovery period to secondary prevention visits that affect your long-term chances of survival.”

With an interest in providing a more accurate assessment of the potential differences in outcomes among stroke patients at 10 years after their index event, Lichtman and a team of colleagues designed the current study as an analysis of fee-for-service Medicare beneficiaries. For the purpose of their analysis, investigators limited their study population to patients discharged alive from US acute-care facilities with a principal diagnosis of ischemic stroke from 2005-2007.

Patients identified were followed through 2016 to calculate 10-year all-cause mortality. In total, investigators identified 744,044 patients for inclusion in the study. These patients had a mean age of 78.7 years, 54.7% were women, 85.6% were White, 9.9% were Black, and 4.5% identified as another race.

Investigators designed their study to use inverse probability weighting to assess racial differences in mortality among this cohort. Additionally, logistic regression was used to calculate the probability of a patient being black as a function of age, Medicaid eligibility, comorbidities, in-hospital complications, discharge disposition, length of stay, and Medicare payment.

Of note, Black patients were more likely to be younger and were more often women. Additionally, investigators noted racial differences in comorbidities. Specifically, renal failure, dementia, and diabetes were more common in Black patients while atherosclerosis and COPD were more common in White patients.

Upon analysis, investigators found the 10-year mortality rate for the overall study population was 75.3% (95% CI, 75.2-75.4). The highest mortality rate was seen among Black patients at 76.4% (95% CI, 76.1-76.7), followed by White patients at 75.4% (95% CI, 75.3-75.5), and those of other races at 70.3% (95% CI, 69.8-70.8). In their IPW analysis, results indicated the risk of death was 4% (RR, 1.04; 95% CI, 1.03-1.04) greater among Black patients but 8% (RR, 0.92; 95% CI, 0.90-0.93) lower among other races when compared to White patients.

“These are racial differences in long-term stroke survivorship, and these differences start within the first year after a stroke,” Lichtman said. “We need to take a closer look at the recovery period and think about how we can optimize secondary prevention and post-stroke care for everybody. Stroke care during the first year after a stroke plays an important role in the long run.”

This study, “Race Differences in 10-Year Mortality After Ischemic Stroke,” was presented at ISC 21 and published in Stroke.