Abstract T P128: Ethnicity and the Availability of Rehabilitation Facilities in the Brain Attack Surveillance in Corpus Christi Project

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sarah Reeves ◽  
Micah Aaron ◽  
Michael Fuentes ◽  
Lewis Morgenstern ◽  
Lynda Lisabeth
Keyword(s):  
Ethnic Differences ◽  
Mexican Americans ◽  
Stroke Rehabilitation ◽  
Inpatient Rehabilitation ◽  
Population Based ◽  
Stroke Survivors ◽  
Market Area ◽  
Post Stroke ◽  
Corpus Christi ◽  
Rehabilitation Facilities

Background: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs). One explanation may be ethnic differences in post-stroke rehabilitation; despite its effectiveness, non-clinical factors such as geographic availability may influence use of certain rehabilitation venues. We investigated ethnic differences in availability of stroke rehabilitation venues in a bi-ethnic community. Methods: Stroke survivors were identified through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project from 2011-2013 in Nueces County, a bi-ethnic, mostly urban community in southeast Texas with a population of 340,000. Addresses of inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) providing stroke rehabilitation were identified by phone/internet and geocoded. Availability was defined as distance to and supply of each type of venue in relation to the survivor’s home. Supply was calculated as the count of each type of venue within a given radius (defined as the 90th percentile of distribution of distances to reflect a reasonable market area). Associations between availability and ethnicity were modeled using linear regression adjusted for census tract-level median household income, proportion <65 years, and population density as obtained from the 2012 American Community Survey. Results: A total of 942 survivors were eligible (62% MA, 38% NHW); 3 IRFs and 21 SNFs were identified. The average distances from the survivors’ homes to an IRF or SNF were 5 miles (SD=6) and 2 miles (SD=3), respectively. Supply was calculated within radii of 16 miles for IRFs and 4 miles for SNFs. The average count of rehabilitation venues within these radii was 2.6 IRFs (SD=0.9) and 7.9 SNFs (SD=4.7). There were no ethnic differences in the distance or supply of IRFs; however, MAs were on average 1 mile (CI:0.6-1.5) closer to and had 0.8 (CI:0.2,1.3) more SNFs within the radius than NHWs. Conclusions: Availability of rehabilitation venues was high for both ethnic groups; however, MAs have greater availability of SNFs compared to NHWs. Additional study is necessary to understand how the availability and quality of services within rehabilitation venues impact post-stroke rehabilitation among MA stroke survivors.

Abstract WP165: Mexican Americans Receive Less Intensive Stroke Rehabilitation Than non Hispanic Whites

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Lewis B Morgenstern ◽  
Emma Sais ◽  
Michael Fuentes ◽  
Nneka Ifejika ◽  
Xiaqing Jiang ◽  
...  
Keyword(s):  
Mexican Americans ◽  
Stroke Rehabilitation ◽  
Inpatient Rehabilitation ◽  
Population Based ◽  
Cognitive Outcomes ◽  
Rehabilitation Services ◽  
Population Based Study ◽  
Corpus Christi ◽  
Home Based ◽  
Chi Squared

Background: Mexican Americans (MAs) have worse neurologic, functional and cognitive outcomes after stroke than non Hispanic whites (NHWs). Stroke rehabilitation is important for outcome. In a population-based study, we sought to determine if allocation of stroke rehabilitation services differed by ethnicity. Methods: Consecutive stroke patients were identified for a three month time period as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, Texas, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for three months following stroke to determine self-reported rehabilitation services. Descriptive statistics were used to describe the study population. Ethnic comparisons of rehabilitation services were made using chi-squared or Fisher’s exact tests. Results: Seventy-two subjects (50 MA, 22 NHW) were followed. Mean age, NHW-69 (sd-13), MA-66 (sd-11) years, sex (NHW 55% male, MA 50% male) and median presenting NIHSS (NHW-2.5, MA-3.0) did not differ significantly. There were no ethnic differences in the proportion of patients who were discharged home without rehabilitation services (p=0.9). Among those who received rehabilitation (n=48), the figure shows the distribution of the first place for services. NHWs were more likely to be discharged to inpatient rehabilitation (73%) compared with MAs (30%), p=0.016. MAs (51%) were much more likely to be receive home rehabilitation services compared with NHWs (0%) (p=0.0017). Conclusions: In this population-based study, MAs were more likely to receive home-based rehabilitation while NHWs more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.

Abstract WP211: Ethnic Differences in Cognitive Recovery 3 Months Following Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Emily M Briceño ◽  
Liming Dong ◽  
Lynda D Lisabeth ◽  
Lewis B Morgenstern
Keyword(s):  
Ethnic Differences ◽  
Mexican Americans ◽  
Robust Regression ◽  
Change Score ◽  
Population Based ◽  
Cognitive Outcomes ◽  
Population Based Study ◽  
Cognitive Recovery ◽  
Post Stroke ◽  
Corpus Christi

Introduction: Mexican Americans (MA) have worse cognitive outcomes following stroke relative to non-Hispanic whites (NHW). In a population-based study we examined whether MAs and NHWs have different cognition just after stroke (baseline) and different cognitive trajectories at 90 days post stroke. Methods: The sample included 598 participants from the Brain Attack Surveillance in Corpus Christi Project who had ischemic stroke between 2008-2013. Cognitive assessment was the 3MSE (English or Spanish). A change score was calculated (3MSE at 90 days minus 3MSE at baseline). Robust regression was used to examine ethnic differences in cognitive outcomes adjusted for sociodemographics, pre-stroke factors, and clinical stroke characteristics; missing covariate values were imputed with multiple imputation. Results: The sample was 57% MA, 35% NHW, and 8% other race/ethnicity. MAs were younger, had lower educational attainment, and were less likely to have health insurance than NHWs (all p<0.01). MAs showed lower cognitive function at baseline (Table 1) and less cognitive recovery 90 days following stroke compared with NHWs (Table 2), which remained significant after accounting for all covariates (Model 5, Tables 1 and 2). Conclusions: MAs have worse post-stroke baseline cognition and less robust cognitive recovery 90 days following stroke than NHWs. This disparity should be addressed through rehabilitation or other interventions.

Abstract TMP44: Ethnic Differences in Informal Caregiving After Stroke: The Brain Attack Surveillance in Corpus Christi (BASIC) Project

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Cecilia N Hollenhorst ◽  
Lynda D Lisabeth ◽  
Linda C Gallo ◽  
Chia-Wei Hsu ◽  
Sehee Kim ◽  
...  
Keyword(s):  
Marital Status ◽  
Ethnic Differences ◽  
Mexican Americans ◽  
Stroke Care ◽  
Informal Caregiving ◽  
Population Based ◽  
Chi Square ◽  
Population Based Study ◽  
Corpus Christi ◽  
Occupational Goals

Background and Aims: We studied informal (non-paid) caregiving after stroke in a population-based study to determine if differences occurred between Mexican Americans (MAs) and non-Hispanic whites (NHWs). MAs are a less affluent population than NHWs. Family members who provide caregiving may need to interrupt educational and occupational goals to provide this care, which may perpetuate socioeconomic disparities between minority and majority populations. Methods: Between October, 2014 and December, 2016, stroke subjects in Texas, USA, were interviewed 90 days after stroke to determine if family or friends provided informal, unpaid caregiving, and for which activities of daily living (ADLs) they required help. Chi-square tests were used to assess the association of ethnicity and whom provided the caregiving, as well as ethnicity and the ADLs for which they required help. Ethnic differences between MAs and NHWs in receiving informal caregiving were determined using logistic regression. The odds ratio (OR, 95% CI) is reported with NHW as the referent group. Results: 473 subjects answered the caregiving questions. There were no significant differences among the two ethnic groups with respect to age, sex, NIHSS score, marital status, or insurance. MAs were more likely to require help compared with NHWs for walking (p=0.0008), bathing (p=0.0004), hygiene (p=0.0018), eating (p=0.0059), dressing (p<0.0001), moving (p=0.0015) and toileting (p=0.0007). Among all subjects, 144 (30%) received informal caregiving (35% of 300 MAs versus 22% of 173 NHWs). There were no significant ethnic differences among which family member provided the caregiving. MAs were more likely to have informal caregiving OR=1.87 (95% CI 1.11-3.13) adjusted for age, sex, NIHSS, education, insurance and marital status. Conclusions: In this population-based study, MAs required more help than NHWs for assistance with ADLs, and MAs were more likely to receive this help through informal, unpaid caregiving than NHWs. Efforts to help minority and low-resource populations provide stroke care are needed.

Abstract T P132: Rapid loss of the Mexican American Survival Advantage After Stroke--The BASIC Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Lewis B Morgenstern ◽  
Brisa N Sánchez ◽  
Melinda Smith ◽  
Devin Brown ◽  
Nelda Garcia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Ethnic Differences ◽  
Mexican Americans ◽  
Mexican American ◽  
Population Based ◽  
Survival Advantage ◽  
Stroke Severity ◽  
Basic Study ◽  
Entire Study ◽  
Corpus Christi

Background/Objective: As a primary, pre-specified objective of the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project we studied trends in mortality following ischemic stroke among Mexican Americans (MAs) and non Hispanic whites (NHWs). MAs were previously found to have lower mortality following stroke than NHWs. Methods: We performed active and passive surveillance, and using source documentation, validated all ischemic stroke cases from January, 2000-December, 2010. Deaths were ascertained from the Texas Department of Health through December 31, 2011. Cumulative 30 day and 1 year mortality adjusted for covariates was estimated using log-binomial models with a linear term for year of stroke onset used to model time trends. Pre-specified adjustment factors were: age, sex, prior stroke or TIA, atrial fibrillation, diabetes, heart disease, hypertension, smoking, high cholesterol and stroke severity. Models used data from the entire study period to estimate adjusted mortality among stroke cases in 2000 and 2010, and to calculate projected ethnic differences. Results: There were 1,822 ischemic strokes among NHWs and 2,211 among MAs. Between 2000 and 2010, 30 day and 1 year mortality declined among NHWs, from 8.6% to 5.9% (p=0.14), and 21.7% to 17.0% (p=0.06), respectively. Among MAs, 30 day mortality remained stagnant at 5.6% (p=0.98), and a slight decline from 18.3% to 16.4% was observed for 1 year mortality (p=0.41). While, the ethnic differences in 30 day (p=0.01) and 1 year (p=0.07) mortality were robust in 2000, they were not so in 2010 (30 day, p=0.76; 1 year p=0.78). See figure. MAs are projected to have higher post-stroke mortality by 2022. Conclusions: Overall, mortality following ischemic stroke has declined in the last decade. However, the survival advantage previously documented among MAs vanished by 2010. Further, faster declines in mortality among NHWs than MAs imply a reversal of the survival advantage by approximately 2022.

Abstract WP173: Mexican Americans Less Likely to Return to Work Following Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Lesli Skolarus ◽  
Jeffrey J Wing ◽  
Lewis B Morgenstern ◽  
Lynda D Lisabeth
Keyword(s):  
High School ◽  
Return To Work ◽  
Ethnic Differences ◽  
Mexican Americans ◽  
Ethnic Difference ◽  
Public Health Problem ◽  
Stroke Recovery ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Post Stroke

Introduction: Lost earnings are the largest driver of the projected $2.2 trillion in stroke costs over the next 4 decades. Mexican Americans (MA) are more likely to have a working age stroke and suffer greater post-stroke disability than non-Hispanic whites (NHW). Thus, we explored ethnic differences in post-stroke return to work and whether sociodemographics and stroke severity contribute to ethnic differences. Methods: Ischemic stroke patients were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) study from August 2011-December 2013. Employment status was obtained at baseline and 90-day interviews conducted with patients or proxies. Sequential logistic regression models were built to assess ethnic difference in return to work after accounting for: 1) age (<65 vs ≥65), sex; 2) 90-day NIH stroke score, and 3) education (<high school vs. ≥high school). Results: Of the 729 MA and NHW stroke survivors who completed the baseline interview, 197 (27%) were working at the time of their stroke of which 125 completed the 90-day outcome interview. There were no ethnic differences in sex or the proportion over the age of 65. MAs had less education (5% vs. 24% college graduate, p<0.01) and greater median 90-day stroke severity (2 vs. 1, p=0.02) than NHWs. Forty-nine (40%) stroke survivors returned to work. MAs were less likely to return to work (OR= 0.45, 95% CI 0.22-0.94) than NHWs. This difference remained after accounting for age and sex (OR=0.45, 95% CI 0.21-0.94). The ethnic difference was attenuated and became non-significant after adjusting for stroke severity (0.59, 95%CI 0.24-1.24) and further attenuated after accounting for education (0.85, 95% CI 0.32, 2.22). In the fully adjusted model, lower stroke severity and higher education were associated with return to work. Conclusion: MAs are less likely to return to work after stroke than NHWs. This finding is important given that MAs are younger and poorer at the time of their stroke suggesting a crucial public health problem. Future work should consider including return to work as part of patient centered outcomes and efforts to optimize stroke recovery.

Abstract 87: Eighteen-Year Trends in Ischemic Stroke Rates in a Bi-Ethnic Population

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Lynda D Lisabeth ◽  
Devin Brown ◽  
Xingyu Zhang ◽  
Sehee Kim ◽  
Erin Case ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Mexican Americans ◽  
Ethnic Disparities ◽  
Population Based ◽  
Rate Difference ◽  
Corpus Christi ◽  
Interaction Terms ◽  
Annual Population ◽  
Adjusted Rate ◽  
Using Data

Introduction: Elevated stroke rates in Mexican Americans (MA) compared with non-Hispanic whites (NHW) persisted over the first decade of the 21 st century. Our objective was to investigate recent trends in ischemic stroke (IS) rates by ethnicity and age using data from a longstanding population-based study. Methods: ISs were identified in the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2000-2017) and validated by neurologists using a clinical definition. Race-ethnicity was from medical records. Annual population counts from the US Census estimated the at-risk population. Poisson regression was used to model sex-adjusted rate trends by ethnicity and age. Time was modeled using linear and quadratic terms. Ethnic differences were assessed using interaction terms between ethnicity and time. Results: 4,883 ISs were identified (median age 70 (IQR:59-80); 56% MA). Trends varied by ethnicity and age (figure). In those 45-59, rates increased substantially in NHWs (104%; p<0.001 for rate difference 2000-2017) but decreased in MAs (-21.4%; p=0.04 for rate difference 2000-2017) such that, for the first time, rates were higher in NHWs. In those 60-74, rates declined in both ethnic groups through 2010-2011 but then increased and more steeply in NHWs thereafter. In those ≥75, rates declined in MAs, declined sharply in NHWs through 2012 and then increased. Conclusions: New patterns in stroke have emerged. Ethnic disparities have declined as a result of increasing rates in NHWs most notably in midlife. Reasons for increasing rates in recent years are unclear but suggest renewed attention to prevention.

Abstract W P300: Ethnic Differences in Post-Stroke Quality of Life in the Brain Attack Surveillance in Corpus Christi (BASIC) Project

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sarah L Reeves ◽  
Devin Brown ◽  
Jonggyu Baek ◽  
Lewis B Morgenstern ◽  
Lynda D Lisabeth
Keyword(s):  
Quality Of Life ◽  
Ethnic Differences ◽  
Short Form ◽  
Mean Difference ◽  
Physical Domain ◽  
Clinical Factors ◽  
Stroke Outcomes ◽  
Post Stroke ◽  
Corpus Christi

Background: Mexican Americans (MAs) have worse stroke outcomes than non-Hispanic whites (NHWs), which could translate into worse quality of life (QOL). Our objective was to investigate ethnic differences in post-stroke QOL across multiple domains in a bi-ethnic community. Methods: Ischemic stroke survivors, identified through the population-based Brain Attack Surveillance in Corpus Christi (BASIC) Project in Nueces County, Texas, participated in in-person interviews 90 days post-stroke from May 2010 - June 2012. The validated short form stroke-specific QOL (SSQOL) was used to assess overall, physical, and psychosocial QOL; scores range from 1-5 with higher scores representing greater QOL. Tobit regression was used to model unadjusted associations between ethnicity and the 3 QOL domains. Models were then adjusted for the following demographic and clinical factors obtained from the medical record and patient interview: age, sex, education, insurance status, marital status, nursing home residence before stroke, prestroke modified Rankin scale, prestroke Informant Questionnaire on Cognitive Decline in the Elderly, initial NIH stroke scale, risk factors, BMI, and a comorbidity index. Results: A total of 335 ischemic strokes with complete data were identified (66% MA, 34% NHW). QOL was lower among MAs compared to NHWs, both overall (mean difference=-0.3, p=0.02) and in the physical domain (mean difference=-0.4, p=0.008); however, there was no difference in the psychosocial domain (p=0.22). After adjustment for demographic and clinical factors, MAs continued to experience poorer QOL compared to NHWs overall (mean difference=-0.5,p=0.049) and in the physical domain (mean difference=-0.3, p=0.006). Conclusions: Ethnic disparities in stroke outcome extend to QOL, with MAs experiencing substantially worse post-stroke QOL than NHWs. Interventions are urgently needed to improve stroke outcomes among the rapidly growing MA stroke population.

Abstract TP182: Stroke Outcome in Mexican American Immigrants and Non-Immigrants

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Lewis B Morgenstern ◽  
Lynda Lisabeth ◽  
River Gibbs ◽  
Sehee Kim ◽  
Charles Agyemang
Keyword(s):  
Mexican Americans ◽  
Mexican American ◽  
Population Based ◽  
Cognitive Outcome ◽  
Stroke Outcome ◽  
Linear Regression Models ◽  
Corpus Christi ◽  
Project Outcomes ◽  
Stroke Study ◽  
The U.S

Background/Objective: We studied the association of being born outside of the U.S. (immigrant) or born in the U.S. (non-immigrant) with 90 day post-stroke outcomes in a population-based stroke study in Texas. Methods: Stroke cases from 2008-2016 were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) project. Outcomes among survivors included ADL/IADL score (higher scores worse) for functional assessment, 3MSE (cognition, lower scores worse), and NIHSS Score (neurologic, higher scores worse). Weighted linear regression models were used to assess the effect of immigration status on the outcomes. Analysis was completed using multiple imputation and inverse probability weighting to account for differential attrition. Results: Of 935 Mexican Americans available for analysis, 83 were immigrants and 852 were non-immigrants. Immigrants had resided in the U.S. on average 47 years. Immigrants were significantly older (69 vs. 66 years), more likely male (60% vs. 49%), more likely to have atrial fibrillation and have less education than non-immigrants (all p<0.05). No differences in hypertension, diabetes, cholesterol, insurance, smoking or other comorbidities existed. The Table provides the data from the fully adjusted models. Immigrants had better functional outcome (mean difference (MD) = -0.22; p=0.02), and no difference for neurologic outcome (MD= -0.15; p=0.15). There was an association of worse cognitive outcome in immigrants (MD= -5.25; p=0.009), however, the association was explained by attenuated after the adjustment for the lower educational attainment in immigrants (MD= -0.79; p=0.64). Conclusions: In this community, there was no evidence of worse stroke outcome among Mexican American immigrants, who had lived in the U.S. for decades, compared with non-immigrants. Further studies of more recent immigrant populations are warranted.

Abstract W MP105: Long Term Stroke Outcome and Caregiving Among Mexican Americans (MA) and Non-Hispanic Whites (NHW): The Population-Based Brain Attack Surveillance in Corpus Christi (BASIC) Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Brisa N Sanchez ◽  
Lynda Lisabeth ◽  
Darin Zahuranec ◽  
Melinda A Cox ◽  
Nelda Garcia ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Repeated Measures ◽  
Mexican Americans ◽  
Caregiver Strain ◽  
Stroke Survivors ◽  
Basic Study ◽  
Long Term Outcome ◽  
Post Stroke

Background: Long term stroke outcomes in MA are understudied, and the role of informal caregiving and caregiver strain in this population is unknown. We report a pilot study of long-term outcomes in BASIC. Methods: Patients previously interviewed at 90 days post-stroke were invited to participate in a telephone survey related to their 6 or 12 month post-stroke activities of daily living (ADLs) during March-May 2013. ADL score (average of 7 items, range 1-4) was analyzed by self-reported ethnicity using repeated measures models. In a separate sample interviewed at 90 days, patients were asked about willingness to participate in longer term follow-up and a subset of caregivers responded to the caregiver strain index (CSI, range 1-13, higher is worse). Results: Among patients alive at the time of interview, 87% of 39 MA and 74% of 19 NHW participated in the 6 month interview, and 84% of 32 MA and 88% of 8 NHW participated in the 12 month interview. No patients refused at either time point; the remainder could not be contacted. The figure shows trajectories of ADL score by ethnicity, and worsening scores among MA over time. Interest in longer-term follow-up was high (96% of 25 NHWs and 97% of 38 MAs). Caregivers of MA stroke survivors were most often children (41%) followed by spouses (36%), but were spouses (43%) followed by children (29%) for NHWs. Of 29 caregivers interviewed, 54% of MA and 57% of NHW reported being strained (CSI≥7). Caregiver strain was associated with 90-day ADL score: prevalence ratio = 1.34, 95%CI (1.01, 1.76) for 1 unit increase in ADL score. Conclusions: Our data demonstrate the feasibility of recruiting MA stroke survivors for long-term outcome assessments and suggests that MAs have worse functional outcome and greater functional declines than NHWs. The informal caregiver burden is related to functional outcome and is high in both ethnic groups.

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