George Howard1, Claudia S Moy2, Virginia J Howard2, Leslie A McClure2, Dawn O Kleindorfer2, Brett M Kissela2, Suzanne E Judd2, Fredrick W Unverzagt2, Elsayed Z Soliman2, Monika M Safford2, Mary Cushman2, Matthew L Flaherty2, Virginia G Wadley2. 1. From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.). ghoward@uab.edu. 2. From the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Abstract
BACKGROUND AND PURPOSE: At age 45 years, blacks have a stroke mortality ≈3× greater than their white counterparts, with a declining disparity at older ages. We assess whether this black-white disparity in stroke mortality is attributable to a black-white disparity in stroke incidence versus a disparity in case fatality. METHODS: We first assess if black-white differences in stroke mortality within 29 681 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort reflect national black-white differences in stroke mortality and then assess the degree to which black-white differences in stroke incidence or 30-day case fatality after stroke contribute to the disparities in stroke mortality. RESULTS: The pattern of stroke mortality within the study mirrors the national pattern, with the black-to-white hazard ratio of ≈4.0 at age 45 years decreasing to ≈1.0 at age 85 years. The pattern of black-to-white disparities in stroke incidence shows a similar pattern but no evidence of a corresponding disparity in stroke case fatality. CONCLUSIONS: These findings show that the black-white differences in stroke mortality are largely driven by differences in stroke incidence, with case fatality playing at most a minor role. Therefore, to reduce the black-white disparity in stroke mortality, interventions need to focus on prevention of stroke in blacks.
BACKGROUND AND PURPOSE: At age 45 years, blacks have a stroke mortality ≈3× greater than their white counterparts, with a declining disparity at older ages. We assess whether this black-white disparity in stroke mortality is attributable to a black-white disparity in stroke incidence versus a disparity in case fatality. METHODS: We first assess if black-white differences in stroke mortality within 29 681 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort reflect national black-white differences in stroke mortality and then assess the degree to which black-white differences in stroke incidence or 30-day case fatality after stroke contribute to the disparities in stroke mortality. RESULTS: The pattern of stroke mortality within the study mirrors the national pattern, with the black-to-white hazard ratio of ≈4.0 at age 45 years decreasing to ≈1.0 at age 85 years. The pattern of black-to-white disparities in stroke incidence shows a similar pattern but no evidence of a corresponding disparity in stroke case fatality. CONCLUSIONS: These findings show that the black-white differences in stroke mortality are largely driven by differences in stroke incidence, with case fatality playing at most a minor role. Therefore, to reduce the black-white disparity in stroke mortality, interventions need to focus on prevention of stroke in blacks.
Authors: George Howard; Brett M Kissela; Dawn O Kleindorfer; Leslie A McClure; Elsayed Z Soliman; Suzanne E Judd; J David Rhodes; Mary Cushman; Claudia S Moy; Kara A Sands; Virginia J Howard Journal: Neurology Date: 2016-01-20 Impact factor: 9.910
Authors: Dawn Kleindorfer; Joseph Broderick; Jane Khoury; Matthew Flaherty; Daniel Woo; Kathleen Alwell; Charles J Moomaw; Alexander Schneider; Rosie Miller; Rakesh Shukla; Brett Kissela Journal: Stroke Date: 2006-08-31 Impact factor: 7.914
Authors: George Howard; Ron Prineas; Claudia Moy; Mary Cushman; Martha Kellum; Ella Temple; Andra Graham; Virginia Howard Journal: Stroke Date: 2006-03-23 Impact factor: 7.914
Authors: Virginia J Howard; Mary Cushman; Leavonne Pulley; Camilo R Gomez; Rodney C Go; Ronald J Prineas; Andra Graham; Claudia S Moy; George Howard Journal: Neuroepidemiology Date: 2005-06-29 Impact factor: 3.282
Authors: Salvador Cruz-Flores; Alejandro Rabinstein; Jose Biller; Mitchell S V Elkind; Patrick Griffith; Philip B Gorelick; George Howard; Enrique C Leira; Lewis B Morgenstern; Bruce Ovbiagele; Eric Peterson; Wayne Rosamond; Brian Trimble; Amy L Valderrama Journal: Stroke Date: 2011-05-26 Impact factor: 7.914
Authors: George Howard; Daniel T Lackland; Dawn O Kleindorfer; Brett M Kissela; Claudia S Moy; Suzanne E Judd; Monika M Safford; Mary Cushman; Stephen P Glasser; Virginia J Howard Journal: JAMA Intern Med Date: 2013-01-14 Impact factor: 21.873
Authors: Kevin R Krull; Yutaka Yasui; Yadav Sapkota; Yin Ting Cheung; Wonjong Moon; Kyla Shelton; Carmen L Wilson; Zhaoming Wang; Daniel A Mulrooney; Jinghui Zhang; Gregory T Armstrong; Melissa M Hudson; Leslie L Robison Journal: Clin Cancer Res Date: 2019-08-28 Impact factor: 12.531
Authors: Maria Pisu; Joshua Richman; Jerzy P Szaflarski; Ellen Funkhouser; Chen Dai; Lucia Juarez; Edward Faught; Roy C Martin Journal: Epilepsia Date: 2019-06-06 Impact factor: 5.864
Authors: Cheryl D Bushnell; Seemant Chaturvedi; Kathy R Gage; Paco S Herson; Patricia D Hurn; Monik C Jiménez; Steven J Kittner; Tracy E Madsen; Louise D McCullough; Mollie McDermott; Mathew J Reeves; Tatjana Rundek Journal: J Cereb Blood Flow Metab Date: 2018-08-17 Impact factor: 6.200
Authors: Alice J Sheffet; George Howard; Albert Sam; Zafar Jamil; Fred Weaver; David Chiu; Jenifer H Voeks; Virginia J Howard; Susan E Hughes; Linda Flaxman; Mary E Longbottom; Thomas G Brott Journal: Stroke Date: 2017-11-30 Impact factor: 7.914
Authors: Debora Kamin Mukaz; Neil A Zakai; Salvador Cruz-Flores; Louise D McCullough; Mary Cushman Journal: Stroke Date: 2020-10-26 Impact factor: 7.914
Authors: Tali Elfassy; Leslie Grasset; M Maria Glymour; Samuel Swift; Lanyu Zhang; George Howard; Virginia J Howard; Matthew Flaherty; Tatjana Rundek; Theresa L Osypuk; Adina Zeki Al Hazzouri Journal: Stroke Date: 2019-04 Impact factor: 7.914
Authors: Gabriel S Tajeu; Monika M Safford; George Howard; Virginia J Howard; Ligong Chen; D Leann Long; Rikki M Tanner; Paul Muntner Journal: Am J Public Health Date: 2020-03-19 Impact factor: 9.308