African American women have poor long-term survival following ischemic stroke

Qureshi, Adnan I.; Suri, M. Fareed K.; Zhou, Jingying; Divani, Afshin A.

doi:10.1212/01.wnl.0000242756.00084.f9

Cited by 15 publications

(16 citation statements)

References 43 publications

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“…These results were partly confirmed by expanding the dataset with more recently acquired patients and looking at short-term results, demonstrating the same trend toward poorer functional outcome, although higher mortality did not manifest for this shorter time. This finding, plus Qureshi et al's 12 report of higher long-term mortality (without baseline matching, however), suggests that longer term factors may be more important than short-term recovery to survival for black women after stroke. The consequences of a much higher incidence of diabetes mellitus could be one such factor.…”

Section: Discussionmentioning

confidence: 67%

“…5 Although blacks bear a disproportionate burden of stroke incidence and stroke-related morbidity and mortality, [6][7][8][9][10][11] clarification of the role of race in influencing rtPA outcomes has been hampered by small numbers of non-white patients in randomized controlled trials. Qureshi et al 12 have shown long-term mortality for black women was highest among a cohort of blacks and whites. However, the differences in baseline factors, such as stroke severity or differences in subtype, could have explained the higher longer term mortality within this study.…”

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confidence: 99%

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Explicit Consideration of Baseline Factors to Assess Recombinant Tissue-Type Plasminogen Activator Response With Respect to Race and Sex

Murthy

Munoz

McGuire

et al. 2013

Stroke

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Background and Purpose-Sex and race reportedly influence outcome after recombinant tissue-type plasminogen activator (rtPA). It is, however, unclear whether baseline imbalances (eg, stroke severity) or lack of response to thrombolysis is responsible. We applied balancing methods to test the hypothesis that race and sex influence outcome after rtPA independent of baseline conditions. Methods-We mapped group outcomes from the National Institute of Neurological Disorders and Stroke (NINDS) dataset based on race and sex onto a surrogate-control function to assess differences from expected outcomes at their respective National Institutes of Health Stroke Scale and age. Outcomes were also compared for subjects matched individually on key baseline factors using NINDS and 2 recent datasets from southeastern United States. Results-At similar National Institutes of Health Stroke Scale and age, 90-day good outcomes (modified Rankin Score, 0-2) in NINDS were similarly improved after rtPA for white men and women. There was a strong trend for improvement in black men. Conversely, black women treated with rtPA showed response rates no different from the controls. After baseline matching, there were nonsignificant trends in outcomes except for significantly fewer good outcomes in black versus matched white women (37% versus 63%; P=0.027). Pooling the 3 datasets showed a similar trend for poorer shortterm outcome for black women (P=0.054; modified Rankin Score, 0-1). Conclusions-Matching for key baseline factors indicated that race and sex influence outcome most strikingly in black women who demonstrated poorest outcomes after rtPA. This finding supports the hypothesis that poor response to rtPA, rather than differences in baseline conditions, contributes to the worse outcome. This finding requires prospective confirmation.

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Section: Discussionmentioning

confidence: 67%

mentioning

confidence: 99%

Explicit Consideration of Baseline Factors to Assess Recombinant Tissue-Type Plasminogen Activator Response With Respect to Race and Sex

Murthy

Munoz

McGuire

et al. 2013

Stroke

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“…While some authors have found better survival after initial admission with stroke5 and acute myocardial infarction (AMI),6 others, in contrast, have found poor survival after initial admission with AMI7 among ethnic minority groups. Similar inconsistent results have also been reported among the USA ethnic groups 8 – 11. However, many of these studies were either based on localised populations5 7 11 or short-term in their follow-up 7 10.…”

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confidence: 57%

Risk of death after first admission for cardiovascular diseases by country of birth in The Netherlands: a nationwide record-linked retrospective cohort study

Agyemang

Vaartjes

Bots

et al. 2009

Heart

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Risk of death after first admission for cardiovascular diseases by country of birth in The Netherlands: a nationwide record-linked retrospective cohort study Agyemang General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website.

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“…For example, in the National Institute for Neurological Disorders and Stroke (NINDS) tPA trial, African American women had the highest 1-year mortality when compared with white men, white women and African American men. 30 It might, therefore, be inappropriate to generalize outcomes to all women if only one race-ethnic group is represented.…”

Section: Discussionmentioning

confidence: 99%

Stroke and the female brain

Bushnell

2008

Nat Rev Neurol

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Stroke is a major public health problem. The female population carries a higher stroke burden than the male population, both because females have a longer life expectancy and because most stroke deaths occur in women. Differences between the sexes in relation to stroke are increasingly being recognized; for example, among stroke survivors, women tend to have worse outcomes than men, as indicated by more-severe disability and an increased likelihood of institutionalization in women. Women and men with stroke also differ in their risk factor profiles, and they respond differently to primary-prevention and acute stroke treatment. Women experience variations in endogenous estrogens throughout their life cycle and might also be exposed to exogenous estrogens, both of which markedly affect the brain. An understanding of the effects of endogenous and exogenous estrogens on cerebral hemodynamics could guide research into explaining how hormone therapy increases the risk of stroke in postmenopausal women. This Review summarizes the sex differences related to stroke, and the effect of endogenous and exogenous hormones on the cerebrovasculature of the female brain. It also proposes potential research approaches, the results of which could fill in gaps in our knowledge regarding the mechanism of action of estrogen in the brain.

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African American women have poor long-term survival following ischemic stroke

Abstract: Compared with whites and men, African American women have a lower 1-year survival following ischemic stroke.

Cited by 15 publications

References 43 publications

Explicit Consideration of Baseline Factors to Assess Recombinant Tissue-Type Plasminogen Activator Response With Respect to Race and Sex

Explicit Consideration of Baseline Factors to Assess Recombinant Tissue-Type Plasminogen Activator Response With Respect to Race and Sex

Risk of death after first admission for cardiovascular diseases by country of birth in The Netherlands: a nationwide record-linked retrospective cohort study

Stroke and the female brain

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