Where to focus efforts to reduce the black-white disparity in stroke mortality: Incidence versus case fatality?

Academic Article

Abstract

  • © 2016 American Heart Association, Inc. 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.
  • 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