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Race/Ethnic and Stroke Subtype Differences in Poststroke Functional Recovery After Acute Rehabilitation

  • Kent P. Simmonds
    Correspondence
    Corresponding author Kent P. Simmonds, PhD, MPH, Michigan State University, Epidemiology and Biostatistics, 909 Wilson Rd, West Fee Hall, Room 317, East Lansing, MI 48824.
    Affiliations
    Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI

    DO/PhD Program, College of Osteopathic Medicine, Michigan State University, East Lansing, MI
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  • Zhehui Luo
    Affiliations
    Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
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  • Mathew Reeves
    Affiliations
    Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI
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Published:March 05, 2021DOI:https://doi.org/10.1016/j.apmr.2021.01.090

      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)
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