Neighborhood socioeconomic disadvantage and mortality after stroke
Manoj K.Mittal, Neurocritical Care Fellow, Mayo Clinic, Rochester, MNmittal.manoj@mayo.edu
Jennifer B. McCormick, Rochester, MN
Submitted July 01, 2013
Brown et al. reported higher post-stroke mortality among residents of the
most socioeconomic disadvantaged census tracts relative to the residents
of the least disadvantaged census tracts.[1] The authors did not find any
association by race or income.
Table e-2 shows that whites have 1.49 times higher risk of post-stroke
mortality at 1 year (p value=0.06). Interestingly, a previous
cardiovascular health study showed 2.9 times higher risk of post-stroke
mortality in blacks (p value less than 0.05).[2] This association of race
and mortality is surprising. The authors could address this paradox by
comparing the race/ethnicity of participants who were excluded secondary
to geocoding issues with their addresses to those who were included.
Other potential confounders could be patient mobility status and use of IV
thrombolysis, which are independent risk factors for post-stroke
mortality.[2-4] Black race and low income are significant predictors for
not receiving IV thrombolysis.[5] The effect of neighborhood on mortality
should be adjusted for mobility status and use of IV thrombolysis.
Better health policies are needed to improve access of care for minorities
and the poor to provide life-saving, FDA approved treatments like IV
thrombolysis and post-stroke care.
DISCLAIMER: The views expressed by authors do not represent the views of
the Mayo Clinic.
1. Brown AF, Liang LJ, Vassar SD, et al. Neighborhood socioeconomic
disadvantage and mortality after stroke. Neurology 2013; 80:520-527
2. Longstreth WT, Bernick C, Fitzpatrick A, et al. Frequency and
predictors of stroke death in 5,888 participants in the Cardiovascular
Health Study. Neurology 2001;56:368-375.
3. Webster F, Saposnik G, Kapral MK, Fang J, O'Callaghan C, Hachinski V.
Organized Outpatient Care: Stroke Prevention Clinic Referrals Are
Associated With Reduced Mortality After Transient Ischemic Attack and
Ischemic Stroke. Stroke 2011;42:3176-3182.
4. Fischer U, Mono M-L, Zwahlen M, et al. Impact of Thrombolysis on Stroke
Outcome at 12 Months in a Population: The Bern Stroke Project. Stroke
2012;43:1039-1045.
5. Kimball MM, Neal D, Waters MF, Hoh BL. Race and Income Disparity in
Ischemic Stroke Care: Nationwide Inpatient Sample Database, 2002 to 2008.
Journal of Stroke and Cerebrovascular Diseases 2013.
For disclosures, please contact the journal at journal@neurology.org.
Brown et al. reported higher post-stroke mortality among residents of the most socioeconomic disadvantaged census tracts relative to the residents of the least disadvantaged census tracts.[1] The authors did not find any association by race or income. Table e-2 shows that whites have 1.49 times higher risk of post-stroke mortality at 1 year (p value=0.06). Interestingly, a previous cardiovascular health study showed 2.9 times higher risk of post-stroke mortality in blacks (p value less than 0.05).[2] This association of race and mortality is surprising. The authors could address this paradox by comparing the race/ethnicity of participants who were excluded secondary to geocoding issues with their addresses to those who were included. Other potential confounders could be patient mobility status and use of IV thrombolysis, which are independent risk factors for post-stroke mortality.[2-4] Black race and low income are significant predictors for not receiving IV thrombolysis.[5] The effect of neighborhood on mortality should be adjusted for mobility status and use of IV thrombolysis. Better health policies are needed to improve access of care for minorities and the poor to provide life-saving, FDA approved treatments like IV thrombolysis and post-stroke care.
DISCLAIMER: The views expressed by authors do not represent the views of the Mayo Clinic.
1. Brown AF, Liang LJ, Vassar SD, et al. Neighborhood socioeconomic disadvantage and mortality after stroke. Neurology 2013; 80:520-527
2. Longstreth WT, Bernick C, Fitzpatrick A, et al. Frequency and predictors of stroke death in 5,888 participants in the Cardiovascular Health Study. Neurology 2001;56:368-375.
3. Webster F, Saposnik G, Kapral MK, Fang J, O'Callaghan C, Hachinski V. Organized Outpatient Care: Stroke Prevention Clinic Referrals Are Associated With Reduced Mortality After Transient Ischemic Attack and Ischemic Stroke. Stroke 2011;42:3176-3182.
4. Fischer U, Mono M-L, Zwahlen M, et al. Impact of Thrombolysis on Stroke Outcome at 12 Months in a Population: The Bern Stroke Project. Stroke 2012;43:1039-1045.
5. Kimball MM, Neal D, Waters MF, Hoh BL. Race and Income Disparity in Ischemic Stroke Care: Nationwide Inpatient Sample Database, 2002 to 2008. Journal of Stroke and Cerebrovascular Diseases 2013.
For disclosures, please contact the journal at journal@neurology.org.