Post-Stroke Health Better Among Young Minority Patients Than White Patients

Daniel Woo, MD, MSc

A new study from the National Institute of Neurological Disorders and Stroke found young black and Hispanic patients fare better after a stroke than young white patients.

Results of the study, which examined more than 400 patients following hemorrhagic stroke, indicated young black patients and young Hispanic patients had a 58% and 66% lower risk, respectively, of being functionally disabled or dying within 3 months as young white patients.

“Our study found that even when you account for factors that affect outcomes, such as how big the stroke is, race and ethnicity were still independent predictors of how well people would recover,” lead investigator Daniel Woo, MD, MSc, a neurologist at the University of Cincinnati, said in a statement.

With limited data on how young patients fare following intracerebral hemorrhage, investigators conducted an analysis of patients under the age of 50 from the Ethnic/Racial Variations of Intracerebral hemorrhage (ERICH) study. In short, the ERICH study is a prospective multicenter study of intracerebral hemorrhage in adults 18 and older. The study included 1000 non-Hispanic white, non-Hispanic black, and Hispanic adults from 42 recruiting sites.

A total of 418 cases—among them involving 173 black and 197 Hispanic patients—were included in the current analysis. The study population had a mean age of 43 (6) years and 69% were men.

Modified Rankin Score (mRS) was used by investigators to evaluate the functional outcomes of patients included in the study—mRS score at 3 months after intracerebral hemorrhage was used as the primary outcome of the study. A poor outcome was defined as a score of 4 or greater on the mRS, which indicated the patient had died or was suffering from some degree of functional disability.

Among the entire study cohort, 35% (n = 146) of all patients were classified as having a poor outcome at 3 months—including 73 who were unable to walk without assistance. Investigators noted 32 were bedridden, incontinent, and required instant nursing attention and 41 had died.

In a multivariable analysis adjusted for age, baseline disability, admission blood pressure, admission Glasgow Coma Scale score, intracerebral hemorrhage volume, deep intracerebral hemorrhage location, and intraventricular extension, black patients had a 58% lower risk (OR, 0.42; 95% CI, 0.18 - 0.99; P = .046) of poor functional outcome at 3 months and Hispanic patients were at a 66% lower risk (OR, 0.34; 95% CI, 0.15 - 0.78; P = .01) compared to young white patients.

Investigators performed a secondary analysis including patients without 3-month mRS scores and this did not impact significantly alter the results of the previously mentioned analysis. Specifically, black patients had a 55% lower risk (OR, 0.45; 95% CI, 0.22, 0.94; P = .032) of a poor outcome at 3 months and Hispanic patients had 64% lower risk (OR, 0.36; 95% CI, 0.18, 0.74; P=.005) at 3 months compared to young white patients.

Investigators noted multiple limitations within their suited including being unable to categorize cultural and racial subgroups, a disproportionate number of white participants, they were unable to assess the importance of intracerebral hemorrhage stability on outcomes, and a significant number of cases were missing data. Additionally, the size of the cohort may not have been large enough to capture differences in racial subgroups.

This study, “Race/ethnicity influences outcomes in young adults with supratentorial intracerebral hemorrhage,” was published online in Neurology.