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

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

Research output: Contribution to journalArticle

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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 languageEnglish (US)
Pages (from-to)805-812
Number of pages8
JournalStroke
Volume50
Issue number4
DOIs
StatePublished - Apr 1 2019

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Survivors
Stroke
Mortality
Long-Term Care
Social Class
Demography

Keywords

  • income
  • mortality
  • social class
  • stroke
  • survivors

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States. / Elfassy, Tali; Grasset, Leslie; Glymour, M. Maria; Swift, Samuel; Zhang, Lanyu; Howard, George; Howard, Virginia J.; Flaherty, Matthew; Rundek, Tatjana; Osypuk, Theresa L.; Zeki Al Hazzouri, Adina.

In: Stroke, Vol. 50, No. 4, 01.04.2019, p. 805-812.

Research output: Contribution to journalArticle

Elfassy, T, Grasset, L, Glymour, MM, Swift, S, Zhang, L, Howard, G, Howard, VJ, Flaherty, M, Rundek, T, Osypuk, TL & Zeki Al Hazzouri, A 2019, 'Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States', Stroke, vol. 50, no. 4, pp. 805-812. https://doi.org/10.1161/STROKEAHA.118.023782
Elfassy T, Grasset L, Glymour MM, Swift S, Zhang L, Howard G et al. Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States. Stroke. 2019 Apr 1;50(4):805-812. https://doi.org/10.1161/STROKEAHA.118.023782
Elfassy, Tali ; Grasset, Leslie ; Glymour, M. Maria ; Swift, Samuel ; Zhang, Lanyu ; Howard, George ; Howard, Virginia J. ; Flaherty, Matthew ; Rundek, Tatjana ; Osypuk, Theresa L. ; Zeki Al Hazzouri, Adina. / Sociodemographic Disparities in Long-Term Mortality Among Stroke Survivors in the United States. In: Stroke. 2019 ; Vol. 50, No. 4. pp. 805-812.
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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.",
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AU - Howard, George

AU - Howard, Virginia J.

AU - Flaherty, Matthew

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