Survival After Stroke Better for Blacks01/31/11
MONDAY, Jan. 31 (HealthDay News) -- Although blacks face a
higher risk of having a stroke, they appear to have better odds of
surviving one than whites do, a new study finds.
This finding might seem odd since conventional wisdom says black
patients typically fare worse than whites when it comes to medical
care in general. However, the same trend has been noticed in other
areas such as heart attack and heart failure, hip fractures and
gastrointestinal bleeding, the University of Rochester researchers
"The question is why that might be the case," said study author Dr. Robert Holloway, a professor of neurology.
To answer that question, the researchers looked into several
possibilities, particularly the care patients received. They found
that black patients were more likely than whites to have aggressive
care, which Holloway believes played a major role in their improved
The more aggressive measures included dialysis, a tracheostomy
(a breathing tube) or cardiac resuscitation, Holloway said. Blacks
had a higher rate of these interventions than whites, he noted.
"Maybe part of the difference in survival [between blacks and whites] may be the different rate of life-sustaining intervention," Holloway said.
Why black patients have higher rates of these treatments isn't
known, he added. But part of it may be the care decisions black
patients and their families make compared to the ones white
patients and their families make, Holloway said.
However, Dr. Larry B. Goldstein, a professor of neurology and
director of the Duke Stroke Center at Duke University Medical
Center thinks the reason may be biological.
"Stroke severity is the single most important determinant of outcome," he said. "African Americans more commonly have small vessel-type strokes than non-African Americans, which are generally less severe and have a better prognosis than large-vessel distribution strokes," Goldstein said.
Holloway agreed. "We can't exclude that possibility," he said.
"But there is something going on that is more than just small
vessel versus large vessel -- there is something more there. My gut
tells me [the care they are getting] has to be part of the
The report is published in the Feb. 1 issue of the
Annals of Internal Medicine.
For the study, Holloway's team collected data on 5,319 black
patients and 18,340 white patients hospitalized for stroke from
January 2005 to December 2006.
During follow-up, 5 percent of the black patients died in the
hospital, compared with 7.4 percent of the white patients. After 30
days, 6.1 percent of the black patients died from any cause,
compared with 11.4 percent of the white patients, the researchers
After one year, 16.5 percent of the black patients had died,
compared with 24.4 percent of the white patients, they
In addition, black patients were 22 percent more likely to
receive more aggressive care than whites.
Moreover, compared with white patients, black patients were 75
percent less likely to be admitted to a hospice after leaving the
hospital, Holloway's group found.
Holloway thinks these findings are important, especially in
light of the new paradigm called patient-centered care. How care
options are explained and decisions about care are made have become
areas that need to be better understood, he said. This includes how
patients and their families make these decisions, he added.
"There is a lot of policy now that uses 30-day mortality as a measure of quality," he said. The question is "are there incidences when you have a well-informed patient who decides to forgo life-sustaining interventions -- that has a higher mortality, but it could be excellent quality," Holloway said. "Using 30-day mortality as a measure of quality may not be as simple as it sounds."
For more information on stroke, visit the
U.S. National Library of Medicine.
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