Abstract
Objective
Significant racial/ethnic disparities in poststroke function exist, but whether these
disparities vary by stroke subtype is unknown. Study goals were to (1) determine if
racial/ethnic disparities in the recovery of poststroke function varied by stroke
subtype and (2) identify confounding factors associated with these racial/ethnic disparities.
Design
Secondary analysis of the 1-year Stroke Recovery in Underserved Populations Cohort
Study.
Setting
Eleven inpatient rehabilitation facilities (IRFs) across the United States.
Participants
A total of 1066 patients (n=868 with ischemic stroke and n=198 with hemorrhagic stroke,
N=1066) who self-identified as White (n=813), Black (n=183), or Hispanic (n=70).
Interventions
Not applicable.
Main Outcome Measures
FIM scores at IRF admission, discharge, 3 months, and 12 months were modeled using
multivariable mixed effects longitudinal regression.
Results
Compared with White patients, Black (−6.1 and −4.6) and Hispanic (−10.1 and −9.9)
patients had significantly lower FIM scores at 3 and 12 months, respectively. A significant
(P<.01) 3-way interaction (race/ethnic*subtype*time) indicated that disparities varied
by stroke subtype. The stroke subtype differences were most prominent for Black-White
disparities because disparities in hemorrhagic stroke were present at IRF admission
(vs 3 months for ischemic stroke). Additionally, at 12 months, the magnitude of Black-White
disparities was over 3 times larger for hemorrhagic stroke (−10.4) than ischemic stroke
(−3.1). Age primarily influenced Black-White disparities (especially for hemorrhagic
stroke), but factors that influenced Hispanic-White disparities were not identified.
Sensitivity analyses showed that there were stroke subtype differences in racial/ethnic
disparities for cognitive (but not motor) function, and results were robust to adjustments
for missing data because of attrition.
Conclusions
There are significant differences between stroke subtypes in the timing and magnitude
of Black-White disparities in poststroke function. Age was a major confounding factor
for Black-White disparities (particularly for hemorrhagic stroke). Overall, Hispanic
patients had the lowest levels of poststroke function, and more work is needed to
identify significant factors that influence Hispanic-White disparities.
Keywords
List of abbreviations:
HS (hemorrhagic stroke), IPW (inverse probability weight), IRF (inpatient rehabilitation facility), IS (ischemic stroke), LTFU (loss to follow-up), SNF (skilled nursing facility), SRUP (Stroke Recovery in Underserved Populations)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 05, 2021
Accepted:
January 21,
2021
Received in revised form:
January 16,
2021
Received:
December 6,
2020
Footnotes
A portion of this work was originally presented to the World Stroke Organization, October 18, 2018, Montreal, Canada.
Disclosures: none
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
