• Ying Xian, Robert G Holloway, Katia Noyes, Manish N Shah, and Bruce Friedman.
• Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27701, USA.
• Ann. Intern. Med. 2011 Feb 1; 154 (3): 152-9.

BackgroundBlack patients are commonly believed to have higher stroke mortality. However, several recent studies have reported better survival in black patients with stroke.ObjectiveTo examine racial differences in stroke mortality and explore potential reasons for these differences.DesignObservational cohort study.Setting164 hospitals in New York.Participants5319 black and 18 340 white patients aged 18 years or older who were hospitalized with acute ischemic stroke between January 2005 and December 2006.MeasurementsInfluence of race on mortality, examined by using propensity score analysis. Secondary outcomes were selected aspects of end-of-life treatment, use of tissue plasminogen activator, hospital spending, and length of stay. Patients were followed for mortality for 1 year after admission.ResultsOverall in-hospital mortality was lower for black patients than for white patients (5.0% vs. 7.4%; P < 0.001), as was all-cause mortality at 30 days (6.1% vs. 11.4%; P < 0.001) and 1 year (16.5% vs. 24.4%; P < 0.001). After propensity score adjustment, black race was independently associated with lower in-hospital mortality (odds ratio [OR], 0.77 [95% CI, 0.61 to 0.98]) and all-cause mortality up to 1 year (OR, 0.86 [CI, 0.77 to 0.96]). The adjusted hazard ratio was 0.87 (CI, 0.79 to 0.96). After adjustment for the probability of dying in the hospital, black patients with stroke were more likely to receive life-sustaining interventions (OR, 1.22 [CI, 1.09 to 1.38]) but less likely to be discharged to hospice (OR, 0.25 [CI, 0.14 to 0.46]).LimitationsThe study used hospital administrative data that lacked a stroke severity measure. The study design precluded determination of causality.ConclusionAmong patients with acute ischemic stroke, black patients had lower mortality than white patients. This could be the result of differences in receipt of life-sustaining interventions and end-of-life care.

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