People who are black have a higher risk of suffering a stroke than those who are white, but a new study finds that following a stroke, blacks have a better survival rate.
The study examined patients hospitalized for an ischemic stroke — a stroke caused by a blockage of blood to the brain. Black patients were approximately 30 percent less likely to die than white patients 30 days after their stroke and 14 percent less likely to have died one year after their stroke, the researchers said.
The differences in survival rates may be due to differences in the use of life-sustaining interventions, such as a breathing tube or feeding tube, the researchers said. Black patients were more likely to receive aggressive, life-sustaining interventions and less likely to be placed in hospice care.
The study did not assess the quality of life for patients after their strokes, the researchers said, which is an important question.
"Even though people who receive aggressive, life-sustaining care have lower mortality, it does not mean they have better quality of care or quality of life," said study researcher Dr. Ying Xian, a former graduate student at University of Rochester Medical Center (URMC) and now at the Duke Clinical Research Institute in Durham, N.C. "Mortality is [an] important measure, but not [the] only measure."
The researchers also noted their finding shows an association, and not a cause-effect link. And because the participants in the study were from the New York area, the results do not necessarily apply to the general population.
Lower risk of death
The results are in line with those of other recent studies that have suggested blacks have a lower risk of dying after a stroke.
The researchers analyzed information from 5,319 non-Hispanic black patients and 18,340 non-Hispanic white patients ages 18 or older. Patients were admitted to a hospital in New York State with a diagnosis of ischemic stroke between January 2005 and December 2006.
During the patients' hospital stay, black patients were more likely to receive aggressive end-of-life treatments, including kidney dialysis, a tracheostomy (a breathing tube inserted in the neck) and cardiopulmonary resuscitation (CPR).
Another possible explanation for mortality differences between blacks and whites after a stroke could be the severity of the stroke, which the study did not take into account, said study researcher Dr. Robert Holloway, a neurologist at URMC.
Other factors in play
But other experts disagreed that the use of life-sustaining interventions explains why blacks have a lower mortality rate after stroke than whites. Many other variables could explain the link, said Charles Ellis, an associate professor at the Medical University of South Carolina, who has also studied racial differences in stroke mortality but was not involved with the new work.
For instance, the study did not take into account the patients' use of rehabilitation services, Ellis said. Also, socioeconomic status was only measured in terms of income, and did not include overall financial, educational, family and community resources.
Because blacks in the study were generally younger — the average age of black patients was 66.9 years, compared with 75.7 years for white patients — "this would suggests that far more blacks were of working age, had greater access to rehabilitative resources and likely utilized them," Ellis said.
In addition, the study did not account for social support from friends and family, which may influence outcomes after a stroke, and did not examine some other life-saving measures, such as control of blood pressure, Ellis said.
The study will be published in the February issue of the journal Annals of Internal Medicine.
Pass it on: After a stroke, blacks have a lower risk of dying than whites, and receive more life-sustaining interventions.
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