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Racial differences in survival post cerebral infarction among the elderly

From the Department of Health Policy and Administration (J. Bian), University of North Carolina at Chapel Hill; Center for Clinical Health Policy Research and Department of Medicine (Drs. Oddone, Samsa, and Matchar) and Department of Biostatistics and Bioinformatics (Dr. Samsa), Duke University, Durham, NC; Veterans Affairs Medical Center (Drs. Oddone and Matchar), Durham, NC; and Outcomes Research Branch (Dr. Lipscomb), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD.

Address correspondence and reprint requests to Dr. Gregory P. Samsa, Center for Clinical Health Policy Research, Duke University Medical Center, 2200 W. Main Street, Suite 220, Durham, NC 27705; e-mail: samsa001{at}mc.duke.edu

Objective: To investigate whether there are differences in poststroke survival between African American and white patients, aged 65 and over, in the United States.

Methods: A biracial cohort of patients was selected from a random 20% national sample of Medicare patients (age 65 and over) hospitalized with cerebral infarction in 1991, and was followed up to a period of 3 years. The Cox regression model was used for covariate adjustment.

Results: A total of 47,045 patients (including 5,324 African Americans) were identified for our analysis. Compared to white patients, African American patients on average were 6% more likely to die post cerebral infarction. The subpopulation analyses further suggest that African Americans age 65 to 74 had much lower 3-year survival probabilities (15 to 20%) than their white counterparts.

Conclusions: The authors find evidence of racial disparities in survival post cerebral infarction among the elderly, although the differences by race are not as great as reported elsewhere for stroke incidence and mortality. Future analyses, using more clinically detailed data, should focus especially on whether survival differences by race persist in the young-old (age 65 to 74) population.

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