Race/Ethnic and Stroke Subtype Differences in Poststroke Functional Recovery After Acute Rehabilitation.
| Autor: | Simmonds KP; Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI; DO/PhD Program, College of Osteopathic Medicine, Michigan State University, East Lansing, MI. Electronic address: Simmond7@msu.edu., Luo Z; Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI., Reeves M; Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI. |
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| Jazyk: | angličtina |
| Zdroj: | Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2021 Aug; Vol. 102 (8), pp. 1473-1481. Date of Electronic Publication: 2021 Mar 05. |
| DOI: | 10.1016/j.apmr.2021.01.090 |
| Abstrakt: | Objective: Significant racial/ethnic disparities in poststroke function exist, but whether these disparities vary by stroke subtype is unknown. Study goals were to (1) determine if racial/ethnic disparities in the recovery of poststroke function varied by stroke subtype and (2) identify confounding factors associated with these racial/ethnic disparities. Design: Secondary analysis of the 1-year Stroke Recovery in Underserved Populations Cohort Study. Setting: Eleven inpatient rehabilitation facilities (IRFs) across the United States. Participants: A total of 1066 patients (n=868 with ischemic stroke and n=198 with hemorrhagic stroke, N=1066) who self-identified as White (n=813), Black (n=183), or Hispanic (n=70). Interventions: Not applicable. Main Outcome Measures: FIM scores at IRF admission, discharge, 3 months, and 12 months were modeled using multivariable mixed effects longitudinal regression. Results: Compared with White patients, Black (-6.1 and -4.6) and Hispanic (-10.1 and -9.9) patients had significantly lower FIM scores at 3 and 12 months, respectively. A significant (P<.01) 3-way interaction (race/ethnic*subtype*time) indicated that disparities varied by stroke subtype. The stroke subtype differences were most prominent for Black-White disparities because disparities in hemorrhagic stroke were present at IRF admission (vs 3 months for ischemic stroke). Additionally, at 12 months, the magnitude of Black-White disparities was over 3 times larger for hemorrhagic stroke (-10.4) than ischemic stroke (-3.1). Age primarily influenced Black-White disparities (especially for hemorrhagic stroke), but factors that influenced Hispanic-White disparities were not identified. Sensitivity analyses showed that there were stroke subtype differences in racial/ethnic disparities for cognitive (but not motor) function, and results were robust to adjustments for missing data because of attrition. Conclusions: There are significant differences between stroke subtypes in the timing and magnitude of Black-White disparities in poststroke function. Age was a major confounding factor for Black-White disparities (particularly for hemorrhagic stroke). Overall, Hispanic patients had the lowest levels of poststroke function, and more work is needed to identify significant factors that influence Hispanic-White disparities. (Copyright © 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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