Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables
| Autor: | Ilse Flores, Anya Umlauf, Neco X Johnson, Susan Magasi, Carolyn Baum, Allen W. Heinemann, Alexis Young, Jennifer J. Manly, Robert K. Heaton, Alex W.K. Wong, María J. Marquine |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Stroke severity Health literacy Neuropsychological Tests Article White People 03 medical and health sciences 0302 clinical medicine Modified Rankin Scale Environmental health Health care Medicine Humans Cognitive Dysfunction 030212 general & internal medicine Aged Insurance Health business.industry General Neuroscience Cognition Middle Aged Health Literacy Black or African American Stroke Psychiatry and Mental health Clinical Psychology Post stroke Racial differences Female Neurology (clinical) business Neurocognitive 030217 neurology & neurosurgery Clinical psychology |
| Popis: | Objectives:The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke.Methods:One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age:M=56.4;SD=12.6; education:M=13.7;SD=2.5; 50% male; years post-stroke: 1–18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale.Results:An independent samplesttest indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score:M=37.63;SD=11.67) than Whites (Fluid T-score:M=42.59,SD=11.54;p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (pp=.02, respectively) and significantly mediated racial differences on neurocognitive impairment.Conclusions:We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017,23, 640–652) |
| Databáze: | OpenAIRE |
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