Abstract Details

Title A Decade of Racial and Ethnic Stroke Disparity: An Insight from Nhanes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) IN6 - (-)

Poster/Presentation
Number 001

Objective

Background In the US, stroke is more prevalent in African Americans (AA) and Hispanics compared to non-Hispanic whites (NHW). We hypothesized that this disparity will be attenuated after controlling for the degree of vascular risk factors control in these populations.

Design/Methods Participants in the National Health and Nutrition Examination Survey (N=40,138) from 2000-2010 were studied. Logistic regression models were created to obtain the odds ratios (OR) and their 95% confidence intervals between stroke and ethnic/racial groups. Demographic, clinical and socioeconomic variables were used as covariates. Hypertension (htn), diabetes (dm) and hypercholesterolemia (hct) were used as binary variables or as ordinal variables (no disease, controlled, undiagnosed, uncontrolled, and untreated). The validity and relevance of each logistic regression was evaluated with the maximum likelihood test. A P of 0.05 or less was considered statistically significant.

Results Uncontrolled or untreated htn were more common in AA than in NHW (P=<0.05) while uncontrolled dm were more common in both, AA and Hispanics (P=<0.05). Age- and sex-adjusted stroke prevalence was higher in AA (OR 1.88, 1.42-2.45) compared to NHW. Controlling for htn, dm, hct, smoking, obesity, increased waist circumference, physical inactivity, income, education and insurance status attenuated the association of stroke with AA (OR 1.16, 0.90-1.15). Using htn, dm, and hct as ordinal instead of categorical variables yielded the lowest possible OR (1.11, 0.75-1.63) between AA and stroke and it was the best fitting model (> 40% fitness improvement, P=<0.001). We didn't find significant differences in stroke prevalence in Hispanics compared to NHW in any of the models.

Conclusions The greater prevalence of stroke in AA compared to NHW is better explained by variables that reflect the diagnosis and control of important vascular risk factors. These results identify targets for interventions to reduce this disparity.

Authors/Disclosures
Jose Gutierrez, MD (Columbia University) PRESENTER	Dr. Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cardiovascular Research Foundation. Dr. Gutierrez has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for White and Rusell. Dr. Gutierrez has received research support from NIH. Dr. Gutierrez has received publishing royalties from a publication relating to health care. Dr. Gutierrez has received publishing royalties from a publication relating to health care.
Andrew D. Hershey, MD, PhD, FAAN, FAHS, FAAN	The institution of Dr. Hershey has received personal compensation in the range of $0-$499 for serving as a Consultant for Amgen. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Lundbeck. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Supernus. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Upsher-Smith. The institution of Dr. Hershey has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva. The institution of Dr. Hershey has received research support from Amgen. The institution of Dr. Hershey has received research support from NIH, NINDS. The institution of Dr. Hershey has received research support from Bioahaven. The institution of Dr. Hershey has received research support from Upsher-Smith. Dr. Hershey has received publishing royalties from a publication relating to health care.

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