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Abstract
Objective: To determine racial and gender differences in long-term survival following ischemic stroke in a well-defined cohort of patients.
Methods: We analyzed the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. We determined the effect of race and gender on 1-year survival ascertained by serial follow-ups using Kaplan–Meier analysis. Multivariate analysis was performed adjusting for age, initial NIH Stroke Scale (NIHSS) score, use of thrombolysis, time to randomization, stroke etiology, and other cardiovascular risk factors.
Results: Of the 547 patients with ischemic stroke, the 1-year survival (percentage ± SE) for African American women (63 ± 6%) was lower than white women (73 ± 4%), African American men (79 ± 4%), and white men (75 ± 3%). Among the 209 patients younger than 65 years, the 1-year survival was prominently lower for African American women (66 ± 8%) vs white women (87 ± 5%), African American men (83 ± 5%), and white men (89 ± 3%). In the Cox proportional hazard analysis, African American women had a significantly higher rate of 1-year mortality (relative risk 2.1, 95% CI 1.2 to 3.5) after adjusting for all potential confounders except diabetes mellitus. After adjustment for diabetes mellitus, the difference became insignificant, although a 70% greater risk of 1-year mortality was still observed.
Conclusions: Compared with whites and men, African American women have a lower 1-year survival following ischemic stroke.
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