DISCLOSURE INFORMATION (relative only): Eric D. Peterson, PI of the AHA GWTG Data Analysis Center; Lee H. Schwamm, Chair of the AHA National Steering Committee.

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Presentation transcript:

DISCLOSURE INFORMATION (relative only): Eric D. Peterson, PI of the AHA GWTG Data Analysis Center; Lee H. Schwamm, Chair of the AHA National Steering Committee for GWTG (unpaid) The racial disparity in stroke is an enormous public concern Despite higher burden of stroke in minorities, limited data exists in comparing mortality for patients with intracerebral hemorrhage of different racial and ethnic backgrounds Background Methods Data from 123,736 patients with intracerebral hemorrhage admitted to 1,199 Get With The Guidelines-Stroke (GWTG) hospitals between Multivariate logistic regressions with generalized estimating equations were performed to evaluate the association between race and in-hospital mortality We adjusted for patient-level characteristics including age, gender, and medical history, as well as hospital-level characteristics including region, hospital type, size, primary stroke center status, percentage of minority patients treated, number of ICH admissions per year, and calendar time Sensitivity analyses among patients with complete National Institutes of Health Stroke Scale score (NIHSS) To determine whether racial/ethnic differences in mortality varied by age, we further examined the interaction between age and race Results Racial/Ethnic Differences in Mortality among Patients Hospitalized with Intracerebral Hemorrhage Ying Xian, 1 Robert G. Holloway, 2 Eric E. Smith, 3 Lee H. Schwamm, 4 Mathew J. Reeves, 5 Margueritte Cox, 1 DaiWai M. Olson, 1 Adrian F. Hernandez, 1 Barbara Lytle, 1 Gregg C. Fonarow, 6 Eric D. Peterson, 1 1 Duke Clinical Research Institute, Durham, NC; 2 University of Rochester, Rochester, NY; 3 Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada; 4 Department of Neurology, Massachusetts General Hospital, Boston, MA; 5 Department of Epidemiology, Michigan State University, East Lansing, MI; 6 Division of Cardiology, University of California, Los Angeles, CA Table 1. Baseline Characteristics by Race Table 2. In-hospital Mortality by Race Conclusions Among patients hospitalized with intracerebral hemorrhage, black, Hispanic, and other racial/ethnic groups have lower risk-adjusted in-hospital mortality compared to white patients, though these racial/ethnic differences were largely confined to patients age 60 years and older FUNDING STATEMENT: The Get With The Guidelines®–Stroke (GWTG-Stroke) program is provided by the American Heart Association/American Stroke Association. The GWTG-Stroke program is currently supported in part by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. GWTG-Stroke has been funded in the past through support from Boeringher-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership and the AHA Pharmaceutical Roundtable. VariableWhite N=83,280 (%) Black N=22,165 (%) Hispanic N=10,541 (%) Other N=7,750 (%) P value Patient characteristics Age, median (IQR)75 (63-83)59 (51-71)64 (52-77)67 (56-79)<.001 Female <.001 Medical history Atrial Fibrillation/Flutter206812<.001 Previous stroke TIA <.001 CAD/prior MI <.001 Carotid stenosis3111<.001 Diabetes mellitus <.001 PVD4221<.001 Hypertension <.001 Smoker <.001 Dyslipidemia <.001 Heart failure5543<.001 NIHSS, median (IQR)9 (3-19)10 (4-19)10 (4-20)11 (4-11)<.001 Hospital characteristics Academic <.001 Primary stroke center <.001 # of beds, median (IQR)391 ( )460 ( )381 ( )365 ( )<.001 # of ICH admission per year 46 (25-79)55 (31-89)48 (28-80)50 (32-83)<.001 Percent of minority, % median IQR 16 (8-29)41 (26-62)46 (27-67)39 (22-62)<.001 Age categoryRace/ethnicity comparison In-hospital mortality, % Adjusted OR (95% CI) Further adjustment for NIHSS (95 %CI) OverallBlack vs. white22.8 vs ( )0.79 ( ) Hispanic vs. white22.7 vs ( )0.73 ( ) Others vs. white25.2 vs ( )0.67 ( ) <50Black vs. white22.1 vs ( )0.87 ( ) Hispanic vs. white21.1 vs ( )0.80 ( ) Others vs. white21.5 vs ( )0.69 ( ) 50-59Black vs. white22.6 vs ( )0.89 ( ) Hispanic vs. white22.8 vs ( )0.83 ( ) Others vs. white22.4 vs ( )0.59 ( ) 60-74Black vs. white21.6 vs ( )0.72 ( ) Hispanic vs. white21.9 vs ( )0.74 ( ) Others vs. white23.1 vs ( )0.61 ( ) >74Black vs. white25.5 vs ( )0.74 ( ) Hispanic vs. white24.5 vs ( )0.66 ( ) Others vs. white30.4 vs ( )0.78 ( ) Compared with white patients, black, Hispanic, and other race were younger Minorities had less comorbidities except for diabetes mellitus and hypertension, and had more severe stroke as documented by NIHSS Black, Hispanic, and other racial/ethnic patients were less likely to die in-hospital than white patients after adjustment for patient and hospital characteristics. The mortality differences remained consistent after further adjustment for NIHSS in NIHSS complete records After examining age and race interaction, the mortality difference was observed in older age groups, but was not evident in younger age groups In contrast to lower mortality, minorities had longer length of stay than white patients (median 6, 6, 6, and 5 days for black, Hispanic, other, and white, respectively, p<.001)