Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States: The REGARDS Study

Tali Elfassy; Leslie Grasset; M. Maria Glymour; Samuel Swift; Lanyu Zhang; George Howard; Virginia J. Howard; Matthew Flaherty; Tatjana Rundek; Theresa L. Osypuk; Adina Zeki Al Hazzouri

doi:10.1161/STROKEAHA.118.023782

Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States: The REGARDS Study

Tali Elfassy, Leslie Grasset, M. Maria Glymour, Samuel Swift, Lanyu Zhang, George Howard, Virginia J. Howard, Matthew Flaherty, Tatjana Rundek, Theresa L. Osypuk, Adina Zeki Al Hazzouri

Epidemiology

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

Background and Purpose - It is unclear whether disparities in mortality among stroke survivors exist long term. Therefore, the purpose of the current study is to describe rates of longer term mortality among stroke survivors (ie, beyond 30 days) and to determine whether socioeconomic disparities exist. Methods - This analysis included 1329 black and white participants, aged ≥45 years, enrolled between 2003 and 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) who suffered a first stroke and survived at least 30 days after the event. Long-term mortality among stroke survivors was defined in person-years as time from 30 days after a first stroke to date of death or censoring. Mortality rate ratios (MRRs) were used to compare rates of poststroke mortality by demographic and socioeconomic characteristics. Results - Among adults who survived ≥30 days poststroke, the age-adjusted rate of mortality was 82.3 per 1000 person-years (95% CI, 75.4-89.2). Long-term mortality among stroke survivors was higher in older individuals (MRR for 75+ versus <65, 3.2; 95% CI, 2.6-4.1) and among men than women (MRR, 1.3; 95% CI, 1.1-1.6). It was also higher among those with less educational attainment (MRR for less than high-school versus college graduate, 1.5; 95% CI, 1.1-1.9), lower income (MRR for <$20k versus >50k, 1.4; 95% CI, 1.1-1.9), and lower neighborhood socioeconomic status (SES; MRR for low versus high neighborhood SES, 1.4; 95% CI, 1.1-1.7). There were no differences in age-adjusted rates of long-term poststroke mortality by race, rurality, or US region. Conclusions - Rates of long-term mortality among stroke survivors were higher among individuals with lower SES and among those residing in neighborhoods of lower SES. These results emphasize the need for improvements in long-term care poststroke, especially among individuals of lower SES.

Original language	English (US)
Pages (from-to)	805-812
Number of pages	8
Journal	Stroke
Volume	50
Issue number	4
DOIs	https://doi.org/10.1161/STROKEAHA.118.023782
State	Published - Apr 1 2019

Bibliographical note

Funding Information:
This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Department of Health and Human Service. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the NIH. Dr Elfassy was supported by the American Heart Association postdoctoral fellowship (17POST32490000) and is currently supported by the University of Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities (KL2TR002737). Dr Zeki Al Hazzouri was supported, in part, by a grant from the NIH, National Institute on Aging (K01AG047273).

Publisher Copyright:
© 2019 American Heart Association, Inc.

Keywords

income
mortality
social class
stroke
survivors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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title = "Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States: The REGARDS Study",

abstract = "Background and Purpose - It is unclear whether disparities in mortality among stroke survivors exist long term. Therefore, the purpose of the current study is to describe rates of longer term mortality among stroke survivors (ie, beyond 30 days) and to determine whether socioeconomic disparities exist. Methods - This analysis included 1329 black and white participants, aged ≥45 years, enrolled between 2003 and 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) who suffered a first stroke and survived at least 30 days after the event. Long-term mortality among stroke survivors was defined in person-years as time from 30 days after a first stroke to date of death or censoring. Mortality rate ratios (MRRs) were used to compare rates of poststroke mortality by demographic and socioeconomic characteristics. Results - Among adults who survived ≥30 days poststroke, the age-adjusted rate of mortality was 82.3 per 1000 person-years (95% CI, 75.4-89.2). Long-term mortality among stroke survivors was higher in older individuals (MRR for 75+ versus <65, 3.2; 95% CI, 2.6-4.1) and among men than women (MRR, 1.3; 95% CI, 1.1-1.6). It was also higher among those with less educational attainment (MRR for less than high-school versus college graduate, 1.5; 95% CI, 1.1-1.9), lower income (MRR for <$20k versus >50k, 1.4; 95% CI, 1.1-1.9), and lower neighborhood socioeconomic status (SES; MRR for low versus high neighborhood SES, 1.4; 95% CI, 1.1-1.7). There were no differences in age-adjusted rates of long-term poststroke mortality by race, rurality, or US region. Conclusions - Rates of long-term mortality among stroke survivors were higher among individuals with lower SES and among those residing in neighborhoods of lower SES. These results emphasize the need for improvements in long-term care poststroke, especially among individuals of lower SES.",

keywords = "income, mortality, social class, stroke, survivors",

author = "Tali Elfassy and Leslie Grasset and Glymour, {M. Maria} and Samuel Swift and Lanyu Zhang and George Howard and Howard, {Virginia J.} and Matthew Flaherty and Tatjana Rundek and Osypuk, {Theresa L.} and {Zeki Al Hazzouri}, Adina",

note = "Funding Information: This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Department of Health and Human Service. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the NIH. Dr Elfassy was supported by the American Heart Association postdoctoral fellowship (17POST32490000) and is currently supported by the University of Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities (KL2TR002737). Dr Zeki Al Hazzouri was supported, in part, by a grant from the NIH, National Institute on Aging (K01AG047273). Publisher Copyright: {\textcopyright} 2019 American Heart Association, Inc.",

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doi = "10.1161/STROKEAHA.118.023782",

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T1 - Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States

T2 - The REGARDS Study

AU - Elfassy, Tali

AU - Grasset, Leslie

AU - Glymour, M. Maria

AU - Swift, Samuel

AU - Zhang, Lanyu

AU - Howard, George

AU - Howard, Virginia J.

AU - Flaherty, Matthew

AU - Rundek, Tatjana

AU - Osypuk, Theresa L.

AU - Zeki Al Hazzouri, Adina

N1 - Funding Information: This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), Department of Health and Human Service. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the NIH. Dr Elfassy was supported by the American Heart Association postdoctoral fellowship (17POST32490000) and is currently supported by the University of Miami Clinical and Translational Science Institute, from the National Center for Advancing Translational Sciences and the National Institute on Minority Health and Health Disparities (KL2TR002737). Dr Zeki Al Hazzouri was supported, in part, by a grant from the NIH, National Institute on Aging (K01AG047273). Publisher Copyright: © 2019 American Heart Association, Inc.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Background and Purpose - It is unclear whether disparities in mortality among stroke survivors exist long term. Therefore, the purpose of the current study is to describe rates of longer term mortality among stroke survivors (ie, beyond 30 days) and to determine whether socioeconomic disparities exist. Methods - This analysis included 1329 black and white participants, aged ≥45 years, enrolled between 2003 and 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) who suffered a first stroke and survived at least 30 days after the event. Long-term mortality among stroke survivors was defined in person-years as time from 30 days after a first stroke to date of death or censoring. Mortality rate ratios (MRRs) were used to compare rates of poststroke mortality by demographic and socioeconomic characteristics. Results - Among adults who survived ≥30 days poststroke, the age-adjusted rate of mortality was 82.3 per 1000 person-years (95% CI, 75.4-89.2). Long-term mortality among stroke survivors was higher in older individuals (MRR for 75+ versus <65, 3.2; 95% CI, 2.6-4.1) and among men than women (MRR, 1.3; 95% CI, 1.1-1.6). It was also higher among those with less educational attainment (MRR for less than high-school versus college graduate, 1.5; 95% CI, 1.1-1.9), lower income (MRR for <$20k versus >50k, 1.4; 95% CI, 1.1-1.9), and lower neighborhood socioeconomic status (SES; MRR for low versus high neighborhood SES, 1.4; 95% CI, 1.1-1.7). There were no differences in age-adjusted rates of long-term poststroke mortality by race, rurality, or US region. Conclusions - Rates of long-term mortality among stroke survivors were higher among individuals with lower SES and among those residing in neighborhoods of lower SES. These results emphasize the need for improvements in long-term care poststroke, especially among individuals of lower SES.

AB - Background and Purpose - It is unclear whether disparities in mortality among stroke survivors exist long term. Therefore, the purpose of the current study is to describe rates of longer term mortality among stroke survivors (ie, beyond 30 days) and to determine whether socioeconomic disparities exist. Methods - This analysis included 1329 black and white participants, aged ≥45 years, enrolled between 2003 and 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) who suffered a first stroke and survived at least 30 days after the event. Long-term mortality among stroke survivors was defined in person-years as time from 30 days after a first stroke to date of death or censoring. Mortality rate ratios (MRRs) were used to compare rates of poststroke mortality by demographic and socioeconomic characteristics. Results - Among adults who survived ≥30 days poststroke, the age-adjusted rate of mortality was 82.3 per 1000 person-years (95% CI, 75.4-89.2). Long-term mortality among stroke survivors was higher in older individuals (MRR for 75+ versus <65, 3.2; 95% CI, 2.6-4.1) and among men than women (MRR, 1.3; 95% CI, 1.1-1.6). It was also higher among those with less educational attainment (MRR for less than high-school versus college graduate, 1.5; 95% CI, 1.1-1.9), lower income (MRR for <$20k versus >50k, 1.4; 95% CI, 1.1-1.9), and lower neighborhood socioeconomic status (SES; MRR for low versus high neighborhood SES, 1.4; 95% CI, 1.1-1.7). There were no differences in age-adjusted rates of long-term poststroke mortality by race, rurality, or US region. Conclusions - Rates of long-term mortality among stroke survivors were higher among individuals with lower SES and among those residing in neighborhoods of lower SES. These results emphasize the need for improvements in long-term care poststroke, especially among individuals of lower SES.

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KW - social class

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Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States: The REGARDS Study

Abstract

Bibliographical note

Keywords

UN SDGs

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