More Aggressive Treatments Improve Stroke Survival Rates in Blacks
African Americans may have a higher risk of stroke, yet a new study finds that blacks have a 30% better survival rate than white patients. The differences in survival appear to be related to the use of aggressive, life-sustaining interventions, say researchers from the University of Rochester Medical Center.
Black Patients 140% More Likely to Survive a Year After Ischemic Stroke
The research team, led by Dr. Robert Holloway, a professor of neurology, analyzed data from 5,319 non-Hispanic black patients and 18,340 non-Hispanic white patients aged 18 and older who were admitted to a hospital in New York State with a diagnosis of ischemic stroke between January 2005 and December 2006.
An ischemic stroke is caused by a blockage of blood to the brain and is the most common type of stroke, accounting for about 87% of all cases. Strokes are the third leading cause of death in the United States and the leading cause of adult disability, according to the American Stroke Association.
Overall, black patients were approximately 30% less likely to die 30 days after their stroke than white patients. They were 14% less likely to have died one year later.
During the patients’ hospital stays, black patients were more likely to receive aggressive end-of-life treatments, including cardiopulmonary resuscitation (CPR), tracheostomy (breathing tube inserted in the neck), feeding tubes, and kidney dialysis. Black patients in the study were generally younger, and therefore likely had greater access to rehabilitative resources, explains Charles Ellis, an associate professor at the Medical University of South Carolina who was not involved with the study but provided his observations to MSNBC.
Another possible explanation for the reasons that black patients survived more often than white patients could be the severity of stroke, although the study did not take this into account either, stresses Dr. Robert Holloway.
“Stroke severity is the single most important determinant of outcome,” says Dr. Larry B. Goldstein, professor of neurology and director of the Duke Stroke Center, also not involved with the original study. "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.
It is also important to note that the study did not assess the quality of life of these patients after their stroke. “Even though people who receive aggressive, life-sustaining care have lower mortality, it does not mean they have better quality of care or quality of life,” says one of the study researchers Dr. Ying Xian. “Mortality is [an] important measure, but not [the] only measure.”
The study will be published in the February issue of the journal Annals of Internal Medicine.