Dataset Information

Racial differences in disability after stroke: results from a nationwide study.

ABSTRACT:

Objective

We sought to characterize racial differences in disability among older stroke survivors.

Methods

A cross-sectional study of 806 self-reported stroke survivors from the 2011 National Health and Aging Trends Study was performed. Race was based on self-report. Primary outcome was activity limitations (requiring assistance with mobility, self-care, and household activities). Secondary outcome was participation restrictions, which were defined as reductions/absence in valued social activities because of health. Physical capacity was measured by a validated scale (0 low-12 high). Logistic regression was used to estimate average marginal effects of activity limitations and participation restrictions by race before and after adjusting for sociodemographics, comorbidities, and physical and cognitive capacity.

Results

Non-Hispanic black participants had lower physical capacity than non-Hispanic white participants (mean 5.1 vs 6.9, p < 0.01). For most activities, black participants had significantly greater limitations than white participants. These differences persisted after accounting for sociodemographic factors and comorbidities, but largely became nonsignificant after accounting for physical capacity. The only unadjusted racial difference in participation restriction was in religious service attendance (18.2% of white participants vs 28.6% of black participants, p < 0.01).

Conclusion

After stroke, black individuals have a greater prevalence of activity limitations than white individuals, largely due to their greater physical capacity limitations. Further understanding of the causes of racial differences in capacity after stroke is needed to reduce activity limitations after stroke and decrease racial disparities.

SUBMITTER: Burke JF

PROVIDER: S-EPMC4132575 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Accurate information on stroke burden in men and women are important for evidence-based healthcare planning and resource allocation. Previously, limited research suggested that the absolute number of deaths from stroke in women was greater than in men, but the incidence and mortality rates were greater in men. However, sex differences in various metrics of stroke burden on a global scale have not been a subject of comprehensive and comparable assessment for most regions of the world, nor have sex differences in stroke burden been examined for trends over time. METHODS:Stroke incidence, prevalence, mortality, disability-adjusted life years (DALYs) and healthy years lost due to disability were estimated as part of the Global Burden of Disease (GBD) 2013 Study. Data inputs included all available information on stroke incidence, prevalence and death and case fatality rates. Analysis was performed separately by sex and 5-year age categories for 188 countries. Statistical models were employed to produce globally comprehensive results over time. All rates were age-standardized to a global population and 95% uncertainty intervals (UIs) were computed. FINDINGS:In 2013, global ischemic stroke (IS) and hemorrhagic stroke (HS) incidence (per 100,000) in men (IS 132.77 (95% UI 125.34-142.77); HS 64.89 (95% UI 59.82-68.85)) exceeded those of women (IS 98.85 (95% UI 92.11-106.62); HS 45.48 (95% UI 42.43-48.53)). IS incidence rates were lower in 2013 compared with 1990 rates for both sexes (1990 male IS incidence 147.40 (95% UI 137.87-157.66); 1990 female IS incidence 113.31 (95% UI 103.52-123.40)), but the only significant change in IS incidence was among women. Changes in global HS incidence were not statistically significant for males (1990 = 65.31 (95% UI 61.63-69.0), 2013 = 64.89 (95% UI 59.82-68.85)), but was significant for females (1990 = 64.892 (95% UI 59.82-68.85), 2013 = 45.48 (95% UI 42.427-48.53)). The number of DALYs related to IS rose from 1990 (male = 16.62 (95% UI 13.27-19.62), female = 17.53 (95% UI 14.08-20.33)) to 2013 (male = 25.22 (95% UI 20.57-29.13), female = 22.21 (95% UI 17.71-25.50)). The number of DALYs associated with HS also rose steadily and was higher than DALYs for IS at each time point (male 1990 = 29.91 (95% UI 25.66-34.54), male 2013 = 37.27 (95% UI 32.29-45.12); female 1990 = 26.05 (95% UI 21.70-30.90), female 2013 = 28.18 (95% UI 23.68-33.80)). INTERPRETATION:Globally, men continue to have a higher incidence of IS than women while significant sex differences in the incidence of HS were not observed. The total health loss due to stroke as measured by DALYs was similar for men and women for both stroke subtypes in 2013, with HS higher than IS. Both IS and HS DALYs show an increasing trend for both men and women since 1990, which is statistically significant only for IS among men. Ongoing monitoring of sex differences in the burden of stroke will be needed to determine if disease rates among men and women continue to diverge. Sex disparities related to stroke will have important clinical and policy implications that can guide funding and resource allocation for national, regional and global health programs.