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April 23, 2019; 92 (17) Article

Racial differences in intervention rates in individuals with ALS

A case-control study

Saman Qadri, Carl D. Langefeld, Carol Milligan, James B. Caress, Michael S. Cartwright
First published March 27, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007366
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Abstract

Objective This study was conducted to determine whether longer lifespans in African Americans with amyotrophic lateral sclerosis (ALS), compared to white non-Hispanics, are secondary to higher rates of tracheostomy and invasive ventilation (TIV) in African Americans.

Methods A retrospective case-control study was conducted with 49 African Americans with ALS matched by age, gender, and site of onset to 137 white persons with ALS.

Results African Americans had longer survival than whites when the outcome was death (p = 0.016), but this was no longer significant when the outcome was death or TIV (p = 0.100). African Americans also had a lower rate of noninvasive ventilation use compared to whites (27 [55%] vs 96 [70%], p = 0.015) and a higher rate of TIV (8 [16%] vs 7 [5%], p = 0.016), but after controlling for baseline severity, only the noninvasive ventilation difference (p = 0.036), and not the TIV difference (p = 0.115), remained significant.

Conclusion African Americans with ALS live longer than white persons with ALS, and this may be secondary to higher rates of TIV use among African Americans.

Glossary

ALS=
amyotrophic lateral sclerosis;
ALSFRS-R=
Amyotrophic Lateral Sclerosis Functional Rating Scale–Revised;
FVC=
forced vital capacity;
NIV=
noninvasive ventilation;
PEG=
percutaneous enteral gastrostomy;
TIV=
tracheostomy and invasive ventilation

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 781

  • CME Course: NPub.org/cmelist

  • Received August 23, 2018.
  • Accepted in final form January 2, 2019.
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