The following is a summary of “Temporal Trends and Racial Disparities in Long-Term Survival After Stroke,” published in the July 2024 issue of Neurology by Robinson et al.

A lack of study exists on long-term stroke outcomes within a broadly representative sample of the population in the US.

Researchers conducted a retrospective study to analyze data from a large stroke study in the Cincinnati area to investigate trends and racial differences in 5-year post-stroke mortality rates.

They identified all residents aged 20 years and older who had acute ischemic strokes (AISs) and intracerebral hemorrhages (ICHs) using ICD codes and verified each case consistently over five periods, July 1993–June 1994, and the calendar years 1999, 2005, 2010, and 2015. Race data came from medical records, including only individuals identified as White or Black. Premorbid functional status was assessed using the modified Rankin Scale, with a score of 0–1 considered “good.” Mortality was evaluated using the National Death Index. Logistic regression analyzed trends and racial disparities for each stroke subtype.

The results showed 8,428 cases of AIS (19.3% Black, 56.3% female, median age 72) and 1,501 cases of ICH (23.5% black, 54.8% female, median age 72). For patients with AIS, 5-year mortality decreased from 53% in 1993/94 to 48.3% in 2015 after adjusting for age, race, and sex (overall study year effect, P=0.009). The absolute decrease in AIS mortality (5.1% vs. 2.8%) exceeded general population trends. Black individuals faced higher post-AIS mortality (OR 1.23, 95% CI 1.08–1.39) after adjusting for age and sex, persisting across study years. Including premorbid status and comorbidities attenuated this effect but showed race interacting with sex and functional status. Among males with good baseline function, Black race remained linked to higher 5-year mortality (OR 1.4, 95% CI 1.1–1.7, P=0.002). No significant changes in 5-year mortality occurred for ICH over time (64.4% in 1993/94 to 69.2% in 2015, overall study year effect, P=0.32).

Investigators concluded that while overall long-term survival improved for patients with AIS, not for ICH, and racial disparities persisted, particularly for black men with good pre-stroke function.

Source: neurology.org/doi/10.1212/WNL.0000000000209653