Abstract TP241: Race-ethnic Differentials Time and Acute Stroke Emergency Presentation: The ASPIRE Study

BACKGROUND: There is sparse data about the nature of race-ethnic disparities in the acute stroke setting including differentials in stroke preparedness. The aim of this analysis was to explore race-ethnic differentials in time to arrival for acute stroke in a racial and ethnically diverse urban setting. METHODS: ASPIRE is a multi-dimensional intervention program (community, hospital, and EMS) for acute stroke preparedness targeted to increase IV tPA utilization in underserved black communities in the DC metro area. We prospectively identified stroke admissions and EMS utilization including acute stroke arrival time parameters for the 6 month pre and post intervention periods. Cox proportional hazards models were used to examine predictors of arrival time. Proportionality of the hazards was checked. RESULTS: In the 6 month pre-intervention period, data was collected on 943 stroke cases; 53% female; 74% black; mean age 67 yrs. Of the subjects from the pre-intervention period with arrival times less than 48 hrs, the median arrival time to the emergency department (ED) was 9 hours; 20% presented under 3 hours. In multivariable Cox PH models, subjects were 38% more likely to arrive earlier if they had arrived by EMS (HR: 1.38, 95%CI: 1.21-1.58). Black subjects were 25% less likely to arrive earlier (HR: 0.75, 95%CI: 0.60-0.93), but this effect was dampened over time (p=0.03). The model included the interaction between black race and time and adjusted for insurance status, risk factors (hypertension and diabetes), gender, age and prior stroke. Ina gender by race analysis, there was a trend towards black women being less likely to arrive earlier to the ED (HR 0.78, 95% CI 0.6 -1.0). However, overall, there was no race-ethnic interaction with arrival by EMS. CONCLUSIONS: Contrary to the perceived perception by the community suggesting there is a disparity in EMS utilization by the black DC community, we found no overall significant racial difference in EMS utilization for acute stroke. While there was a trend towards delayed overall arrival in black females, this was independent of EMS utilization.

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Sex and Race Differences in the Risk of Ischemic Stroke Associated With Fasting Blood Glucose in REGARDS

Neurology ◽

10.1212/wnl.0000000000012296 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012296

Author(s):

Tracy E. Madsen ◽

D. Leann Long ◽

April P. Carson ◽

George Howard ◽

Dawn O. Kleindorfer ◽

...

Keyword(s):

Ischemic Stroke ◽

Blood Glucose ◽

Black Women ◽

Racial Differences ◽

White Women ◽

Proportional Hazards ◽

Fasting Blood Glucose ◽

Cox Proportional Hazards ◽

Race Differences ◽

Prospective Longitudinal

Background:To investigate sex and race differences in the association between fasting blood glucose (FBG) and risk of ischemic stroke (IS).Methods:This prospective longitudinal cohort study included adults age ≥45 years at baseline in the Reasons for Geographic And Racial Differences in Stroke Study, followed for a median of 11.4 years. The exposure was baseline FBG (mg/dL); suspected IS events were ascertained by phone every 6 months and were physician-adjudicated. Cox proportional hazards were used to assess the adjusted sex/race-specific associations between FBG (by category and as a restricted cubic spline) and incident IS.Results:Of 20,338 participants, mean age was 64.5(SD 9.3) years, 38.7% were Black, 55.4% were women, 16.2% were using diabetes medications, and 954 IS events occurred. Compared to FBG <100, FBG ≥150 was associated with 59% higher hazards of IS (95%CI 1.21-2.08) and 61% higher hazards of IS among those on diabetes medications (95%CI 1.12-2.31). The association between FBG and IS varied by race/sex (HR, FBG ≥ 150 vs. FBG <100: White women 2.05 (95% CI 1.23-3.42), Black women 1.71 (95%CI 1.10-2.66), Black men 1.24 (95%CI 0.75-2.06), White men 1.46 (95%CI 0.93-2.28), pFBG*race/sex=0.004). Analyses using FBG splines suggest that sex was the major contributor to differences by race/sex subgroups.Conclusions:Sex differences in the strength and shape of the association between FBG and IS are likely driving the significant differences in the association between FBG and IS across race/sex subgroups. These findings should be explored further and may inform tailored stroke prevention guidelines.

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Racial/ethnic disparities in the risk of intracerebral hemorrhage recurrence

Neurology ◽

10.1212/wnl.0000000000008737 ◽

2019 ◽

Vol 94 (3) ◽

pp. e314-e322 ◽

Cited By ~ 1

Author(s):

Audrey C. Leasure ◽

Zachary A. King ◽

Victor Torres-Lopez ◽

Santosh B. Murthy ◽

Hooman Kamel ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Ethnic Groups ◽

Proportional Hazards ◽

Private Insurance ◽

Multivariable Analysis ◽

Ethnic Disparities ◽

Cox Proportional Hazards ◽

Risk Of Recurrence ◽

Asian Patients ◽

Racial Ethnic

ObjectiveTo estimate the risk of intracerebral hemorrhage (ICH) recurrence in a large, diverse, US-based population and to identify racial/ethnic and socioeconomic subgroups at higher risk.MethodsWe performed a longitudinal analysis of prospectively collected claims data from all hospitalizations in nonfederal California hospitals between 2005 and 2011. We used validated diagnosis codes to identify nontraumatic ICH and our primary outcome of recurrent ICH. California residents who survived to discharge were included. We used log-rank tests for unadjusted analyses of survival across racial/ethnic groups and multivariable Cox proportional hazards regression to determine factors associated with risk of recurrence after adjusting for potential confounders.ResultsWe identified 31,355 California residents with first-recorded ICH who survived to discharge, of whom 15,548 (50%) were white, 6,174 (20%) were Hispanic, 4,205 (14%) were Asian, and 2,772 (9%) were black. There were 1,330 recurrences (4.1%) over a median follow-up of 2.9 years (interquartile range 3.8). The 1-year recurrence rate was 3.0% (95% confidence interval [CI] 2.8%–3.2%). In multivariable analysis, black participants (hazard ratio [HR] 1.22; 95% CI 1.01–1.48; p = 0.04) and Asian participants (HR 1.29; 95% CI 1.10–1.50; p = 0.001) had a higher risk of recurrence than white participants. Private insurance was associated with a significant reduction in risk compared to patients with Medicare (HR 0.60; 95% CI 0.50–0.73; p < 0.001), with consistent estimates across racial/ethnic groups.ConclusionsBlack and Asian patients had a higher risk of ICH recurrence than white patients, whereas private insurance was associated with reduced risk compared to those with Medicare. Further research is needed to determine the drivers of these disparities.

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Improvement of Abandonment of Therapy in Pediatric Patients with Cancer in Guatemala

Journal of Global Oncology ◽

10.1200/jgo.2016.004648 ◽

2016 ◽

Vol 2 (3_suppl) ◽

pp. 76s-76s ◽

Cited By ~ 2

Author(s):

Elysia Alvarez ◽

Midori Seppa ◽

Kevin Messacar ◽

John Kurap ◽

E. Alejandro Sweet-Cordero ◽

...

Keyword(s):

Risk Factors ◽

Psychosocial Intervention ◽

Intervention Program ◽

Proportional Hazards ◽

Conflicts Of Interest ◽

Population Based ◽

Cox Proportional Hazards ◽

Middle Income ◽

Targeted Interventions ◽

Increased Risk

Abstract 59 Background: Abandonment of therapy is a major cause of therapeutic failure in the treatment of childhood cancer in Low and Middle Income Countries (LMIC). This study examines factors associated with increased risk of therapy abandonment in Guatemalan children with cancer and the rates of therapy abandonment before and after implementation of a multidisciplinary psychosocial intervention program. Methods: A retrospective population-based study was performed to identify risk factors for abandonment of therapy in Guatemalan children, ages 0-18, with cancer who were seen at UNOP from 2001-2008. Patient data was collected from the Pediatric Oncology Networked Database (POND4Kids). Abandonment was defined as a lapse of 4 weeks in planned treatment or failure to begin treatment for a potentially curable cancer. Cox proportional hazards analysis identified the effect of age, sex, year of diagnosis, distance travelled to UNOP, ethnicity, and principal diagnosis on abandonment of therapy. Kaplan Meier analysis was used to evaluate survival. Results: A retrospective analysis of 1,789 charts was performed and 367 patients abandoned therapy. The rate of abandonment decreased from 27% in 2001 to 7% in 2008 following a multidisciplinary psychosocial intervention program. Greater distance to UNOP (p = 0.00), younger age (p = 0.02) and earlier year of diagnosis (p = 0.00) were associated with increased risk of abandonment. Abandonment of therapy correlated with decreased survival. The cumulative survival at 8.3 years was 0.57 ± 0.02 (survival±SE) for those who completed therapy vs 0.06 ± 0.02 for those who abandoned and refused therapy (p=0.000) in an abandonment sensitive analysis. Conclusion: This study identified distance, age, and year of diagnosis as risk factors for abandonment of therapy for pediatric cancer in Guatemala. This study highlights risk factors for abandonment of therapy and the role of targeted interventions in altering rates of abandonment that could be replicated in other LMIC countries. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

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Gender differences in time from arrival to stroke team activation in patients presenting with acute stroke symptoms

10.22514/sv.2021.051 ◽

2021 ◽

Keyword(s):

Acute Stroke ◽

Proportional Hazards ◽

Gender Disparity ◽

Cox Proportional Hazards ◽

Activation Time ◽

National Guidelines ◽

Logistic Regression Models ◽

Patient Gender ◽

Stroke Team ◽

Stroke Center

Background and Purpose: Women are more likely to experience delays in evaluation and treatment for acute stroke. As national guidelines increasingly emphasize the importance of rapid stroke intervention, it is important to further investigate this gender disparity. We sought to evaluate whether door-to-stroke activation time varied by patient gender among patients for whom stroke team activation occurred in the emergency department (ED). Methods: This was a retrospective analysis of a prospectively collected registry of all patients for whom the stroke team was activated in the ED of an urban, academic, regional stroke center over 1 year. Our primary outcome was door to stroke activation time (DTA), with the primary predictor of interest being patient gender. We assessed for differences in DTA using multivariable Cox proportional hazards and logistic regression models. Results: There were 211 patient encounters included in the study, 117 women and 94 males. Median DTA was 8 minutes longer for women, and women were less likely to have DTA ≤ 15 minutes (odds ratio 0.26 [95% confidence interval 0.12 to 0.58]). Conclusion: A gender disparity existed in door to activation time for women presenting with suspected acute stroke, even when controlling for a variety of factors. These results provide evidence that gender may impact initial management of stroke patients.

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Abstract 16731: Early Onset of Menopause and Premature Cardiovascular Disease: The Coronary Artery Risk Development in Young Adults Study

Circulation ◽

10.1161/circ.142.suppl_3.16731 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Ruth Misha ◽

Laura A Colangelo ◽

Lucia Petito ◽

Cora E Lewis ◽

Pamela Schreiner ◽

...

Keyword(s):

Cardiovascular Disease ◽

Young Adults ◽

Coronary Artery ◽

Black Women ◽

Early Onset ◽

White Women ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Age At Menarche

Introduction: Cardiovascular disease (CVD) is the leading cause of death in women and early onset of menopause before the age of 40 years has been identified as a risk enhancer for future CVD events. Quantifying the magnitude of risk for premature CVD among women with early menopause may inform and guide the intensity of sex-specific preventive strategies. Methods: We included all women in the Coronary Artery Risk Development in Young Adults (CARDIA) study who attended a follow-up exam after the age of 40 years, had available data on menopausal status, and had not experienced premature CVD before 40 years. We performed multivariable Cox proportional hazards regression to examine the relationship between early onset of menopause defined as <40 years and incident CVD (coronary heart disease, peripheral arterial disease, stroke, and heart failure) prior to the age of 65 years. We performed Cox proportional hazards models and adjusted for risk factors levels at baseline: age, race, age at menarche, years of education, smoking status, body mass index, diabetes, hypertension, and total cholesterol: high-density lipoprotein ratio. Results: Among 2136 women with mean age of 43.0 (SD 3.0), 9.1% reported premature menopause before the age of 40 years (4.5% in white and 13.9% in black women). Over a median follow-up of 14.0 (IQR 11.5, 16.9) years, 81 premature CVD events occurred. Incidence rate (95% CI) of CVD was 6.46 (2.43, 17.22) and 1.41 (0.92, 2.17) per 1,000 per person-years for white women with and without early onset menopause, respectively; 4.94 (2.66, 9.16) and 3.92 (2.94, 5.24) per 1,000 person-years for black women with and without early onset menopause (FIGURE). Conclusions: In a population-based sample, white women with early onset of menopause had a 3-fold higher rate of premature CVD events, independent of perimenopausal risk factor levels. Interventions to intensify CVD prevention in at-risk women are needed following early onset of menopause.

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Serum Uric Acid Is Associated with Poor Outcome in Black Africans in the Acute Phase of Stroke

Stroke Research and Treatment ◽

10.1155/2017/1935136 ◽

2017 ◽

Vol 2017 ◽

pp. 1-9 ◽

Cited By ~ 3

Author(s):

Yacouba N. Mapoure ◽

Chia Mark Ayeah ◽

M. S. Doualla ◽

H. Ba ◽

Hugo B. Mbatchou Ngahane ◽

...

Keyword(s):

Uric Acid ◽

Acute Stroke ◽

Serum Uric Acid ◽

Proportional Hazards ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Proportional Hazards ◽

Stroke Patients ◽

Black African ◽

Poor Outcome

Background.Prognostic significance of serum uric acid (SUA) in acute stroke still remains controversial.Objectives.To determine the prevalence of hyperuricemia and its association with outcome of stroke patients in the Douala General Hospital (DGH).Methods.This was a hospital based prospective cohort study which included acute stroke patients with baseline SUA levels and 3-month poststroke follow-up data. Associations between high SUA levels and stroke outcomes were analyzed using multiple logistic regression and survival analysis (Cox regression and Kaplan-Meier).Results.A total of 701 acute stroke patients were included and the prevalence of hyperuricemia was 46.6% with a mean SUA level of 68.625 ± 24 mg/l. Elevated SUA after stroke was associated with death (OR = 2.067; 95% CI: 1.449–2.950;p< 0.001) but did not predict this issue. However, an independent association between increasing SUA concentration and mortality was noted in a Cox proportional hazards regression model (adjusted HR = 1.740; 95% CI: 1.305–2.320;p< 0.001). Furthermore, hyperuricemia was an independent predictor of poor functional outcome within 3 months after stroke (OR = 2.482; 95% CI: 1.399–4.404;p= 0.002).Conclusion.The prevalence of hyperuricemia in black African stroke patients is quite high and still remains a predictor of poor outcome.

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Reducing Door-to-Needle Times for Ischaemic Stroke to a Median of 30 Minutes at a Community Hospital

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2018.368 ◽

2018 ◽

Vol 46 (1) ◽

pp. 51-56 ◽

Cited By ~ 3

Author(s):

Noreen Kamal ◽

Elaine Shand ◽

Robert Swanson ◽

Michael D. Hill ◽

Thomas Jeerakathil ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Stroke ◽

Community Hospital ◽

Annual Number ◽

Intervention Period ◽

Community Hospitals ◽

Stroke Patients ◽

Post Intervention ◽

Post Intervention Period ◽

Number Of Patients

AbstractBackgroundAlteplase is an effective treatment for ischaemic stroke patients, and it is widely available at all primary stroke centres. The effectiveness of alteplase is highly time-dependent. Large tertiary centres have reported significant improvements in their door-to-needle (DTN) times. However, these same improvements have not been reported at community hospitals.MethodsRed Deer Regional Hospital Centre (RDRHC) is a community hospital of 370 beds that serves approximately 150,000 people in their acute stroke catchment area. The RDRHC participated in a provincial DTN improvement initiative, and implemented a streamlined algorithm for the treatment of stroke patients. During this intervention period, they implemented the following changes: early alert of an incoming acute stroke patient to the neurologist and care team, meeting the patient immediately upon arrival, parallel work processes, keeping the patient on the Emergency Medical Service stretcher to the CT scanner, and administering alteplase in the imaging area. Door-to-needle data were collected from July 2007 to December 2017.ResultsA total of 289 patients were treated from July 2007 to December 2017. In the pre-intervention period, 165 patients received alteplase and the median DTN time was 77 minutes [interquartile range (IQR): 60–103 minutes]; in the post-intervention period, 104 patients received alteplase and the median DTN time was 30 minutes (IQR: 22–42 minutes) (p < 0.001). The annual number of patients that received alteplase increased from 9 to 29 in the pre-intervention period to annual numbers of 41 to 63 patients in the post-intervention period.ConclusionCommunity hospitals staffed with community neurologists can achieve median DTN times of 30 minutes or less.

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Predicted vitamin D status and incidence of tooth loss and periodontitis

Public Health Nutrition ◽

10.1017/s1368980013000177 ◽

2013 ◽

Vol 17 (4) ◽

pp. 844-852 ◽

Cited By ~ 46

Author(s):

Monik Jimenez ◽

Edward Giovannucci ◽

Elizabeth Krall Kaye ◽

Kaumudi J Joshipura ◽

Thomas Dietrich

Keyword(s):

Vitamin D ◽

Lower Incidence ◽

Tooth Loss ◽

Proportional Hazards ◽

Plasma Concentrations ◽

Ethnic Disparities ◽

Vitamin D Insufficiency ◽

Cox Proportional Hazards ◽

Inverse Association ◽

Time Varying Covariates

AbstractObjectiveVitamin D insufficiency is highly prevalent, with particular subgroups at greater risk (e.g. the elderly and those with darker skin). Vitamin D insufficiency may partly explain US racial/ethnic disparities in the prevalence of periodontitis and tooth loss. We evaluated the association between a predictor score of plasma 25-hydroxyvitamin D (25(OH)D) and incidence of periodontitis and tooth loss.DesignDetailed biennial questionnaires were collected on medical history, lifestyle practices and incident periodontitis and tooth loss. The predictor score was derived from variables known to influence circulating concentrations of plasma 25(OH)D and validated against plasma concentrations among a sub-sample. Multivariable Cox proportional-hazards models with time-varying covariates estimated the association between the predicted 25(OH)D score and time until first tooth loss.SubjectsA total of 42 730 participants of the Health Professionals Follow-Up Study aged 40–75 years at baseline were followed from 1986 to 2006.SettingUSA, representing all fifty states and the District of Columbia.ResultsWe observed 13 581 incident tooth loss events from 539 335 person-years. There was a dose-dependent significant inverse association across quintiles of the predicted 25(OH)D score and incidence of tooth loss. In multivariable analyses, the highest quintile of the updated predicted 25(OH)D score compared with the lowest was associated with a 20 % lower incidence of tooth loss (hazard ratio = 0·80, 95 % CI 0·76, 0·85; P value for trend <0·0 0 1); UV-B was also independently associated. Results for the predicted 25(OH)D score and periodontitis were similar.ConclusionsThese results are suggestive of an association between predictors of vitamin D and lower incidence of tooth loss and periodontitis.

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The Impact of Diabetes and Edentulism on All-Cause Mortality: Racial and Ethnic Disparities

Innovation in Aging ◽

10.1093/geroni/igab046.792 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 206-207

Author(s):

Huabin Luo ◽

Frank Sloan ◽

Brenda Plassman ◽

Samrachana Adhikari ◽

Mark Schwartz ◽

...

Keyword(s):

Risk Factor ◽

Ethnic Groups ◽

Proportional Hazards ◽

Ethnic Disparities ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Models ◽

The Us ◽

The Impact ◽

Racial Ethnic ◽

Retirement Study

Abstract This study examined the relationships between the concomitance of diabetes mellitus (DM) and edentulism and mortality among Black, Hispanic, and White older adults in the US. We used data from the 2006-2016 Health and Retirement Study with 2,108 Black, 1,331 Hispanic, and 11,544 White respondents aged 50+. Results of weighted Cox proportional hazards models showed that the concomitance of DM and edentulism was associated with a higher mortality risk for Blacks (Hazard Ratio [HR] = 1.58, p < 0.01), Hispanics (HR = 2.16, p < 0.001) and Whites (HR = 1.61, p < 0.001). Findings also indicated that DM was a risk factor for mortality across all racial/ethnic groups, but edentulism was a risk factor only for Whites (HR = 1.30, p < 0.001). This study revealed that the risk of DM and edentulism on mortality varied among racial/ethnic groups. Our study gives alternative explanations for the observed findings.

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A prospective study of yogurt and other dairy consumption in relation to incidence of type 2 diabetes among black women in the USA

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa143 ◽

2020 ◽

Vol 112 (3) ◽

pp. 512-518

Author(s):

Lynn Rosenberg ◽

Yvonne P Robles ◽

Shanshan Li ◽

Edward A Ruiz-Narvaez ◽

Julie R Palmer

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Black Women ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Health Study ◽

Inverse Association ◽

Low Fat ◽

Dairy Consumption

ABSTRACT Background Yogurt consumption and low-fat dairy consumption have been associated with reduced incidence of type 2 diabetes (T2D) in some studies. Objective We assessed the relation of yogurt and other dairy consumption to incidence of T2D in black women, a population group with a disproportionately high incidence of T2D. Methods The Black Women's Health Study has followed 59,000 US black women since 1995 through biennial questionnaires which update health information. Each questionnaire inquired about doctor-diagnosed diabetes in the previous 2 y. FFQs completed by participants in 1995 and 2001 provided information on yogurt and other dietary intake. HRs with 95% CIs for yogurt (nonfrozen or frozen) and other dairy consumption in relation to incident T2D (n = 8061 cases) were estimated with Cox proportional hazards regression, controlling for risk factors for T2D. Results The HR for consumption of ≥1 serving of yogurt/d relative to <1 serving/mo was 0.99 (95% CI: 0.87, 1.13, P trend = 0.65) after control for dietary and nondietary risk factors for T2D. The multivariable HR was 0.97 (95% CI: 0.75, 1.27; P trend = 0.74) for 2 or more servings/d of low-fat dairy other than yogurt relative to <1 serving/mo and 1.06 (95% CI: 0.91, 1.25, P trend = 0.36) for 2 or more servings/d of regular dairy relative to <1 serving/mo. Conclusion Results from this study do not support an inverse association of yogurt consumption or other dairy consumption with T2D risk in black women.

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