Where to Focus Efforts to Reduce the Black-White Disparity in Stroke Mortality: Incidence Versus Case Fatality?

Academic Article

Abstract

  • BACKGROUND AND PURPOSE: At age 45 years, blacks have a stroke mortality ≈3× greater than their white counterparts, with a declining disparity at older ages. We assess whether this black-white disparity in stroke mortality is attributable to a black-white disparity in stroke incidence versus a disparity in case fatality. METHODS: We first assess if black-white differences in stroke mortality within 29 681 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort reflect national black-white differences in stroke mortality and then assess the degree to which black-white differences in stroke incidence or 30-day case fatality after stroke contribute to the disparities in stroke mortality. RESULTS: The pattern of stroke mortality within the study mirrors the national pattern, with the black-to-white hazard ratio of ≈4.0 at age 45 years decreasing to ≈1.0 at age 85 years. The pattern of black-to-white disparities in stroke incidence shows a similar pattern but no evidence of a corresponding disparity in stroke case fatality. CONCLUSIONS: These findings show that the black-white differences in stroke mortality are largely driven by differences in stroke incidence, with case fatality playing at most a minor role. Therefore, to reduce the black-white disparity in stroke mortality, interventions need to focus on prevention of stroke in blacks.
  • Published In

  • Stroke  Journal
  • Keywords

  • blacks, continental population groups, incidence, mortality, stroke, African Continental Ancestry Group, Age Factors, Age of Onset, Aged, Aged, 80 and over, Anthropometry, Comorbidity, European Continental Ancestry Group, Female, Follow-Up Studies, Health Status Disparities, Humans, Incidence, Male, Middle Aged, Mortality, Odds Ratio, Risk Factors, Stroke, United States
  • Digital Object Identifier (doi)

    Author List

  • Howard G; Moy CS; Howard VJ; McClure LA; Kleindorfer DO; Kissela BM; Judd SE; Unverzagt FW; Soliman EZ; Safford MM
  • Start Page

  • 1893
  • End Page

  • 1898
  • Volume

  • 47
  • Issue

  • 7