Lewis B Morgenstern1, Emma Sais2, Michael Fuentes2, Nneka L Ifejika2, Xiaqing Jiang2, Susan D Horn2, Erin Case2, Lynda D Lisabeth2. 1. From the Stroke Program, University of Michigan Medical School, Ann Arbor (L.B.M., E.S., L.D.L.); Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (L.B.M., X.J., E.C., L.D.L.); Corpus Christi Rehabilitation, TX (M.F.); Department of Neurology, McGovern Medical School at UTHealth, Houston, TX (N.L.I.); and Departments of Biomedical Informatics and Population Health Sciences, University of Utah Medical School, Salt Lake City (S.D.H.). Lmorgens@umich.edu. 2. From the Stroke Program, University of Michigan Medical School, Ann Arbor (L.B.M., E.S., L.D.L.); Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor (L.B.M., X.J., E.C., L.D.L.); Corpus Christi Rehabilitation, TX (M.F.); Department of Neurology, McGovern Medical School at UTHealth, Houston, TX (N.L.I.); and Departments of Biomedical Informatics and Population Health Sciences, University of Utah Medical School, Salt Lake City (S.D.H.).
Abstract
BACKGROUND AND PURPOSE: Mexican Americans (MAs) have worse neurological, functional, and cognitive outcomes after stroke. Stroke rehabilitation is important for good outcome. In a population-based study, we sought to determine whether allocation of stroke rehabilitation services differed by ethnicity. METHODS: Patients with stroke were identified as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, TX, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for 3 months after stroke to determine rehabilitation services and transitions. Descriptive statistics were used to depict the study population. Continuous baseline variables were compared using 2 sample t tests or Wilcoxon rank-sum tests by ethnicity. Categorical baseline variables were compared using χ2 tests. Ethnic comparisons of rehabilitation services were compared using χ2 tests, Fisher's exact tests, and logistic regression. RESULTS: Seventy-two subjects (50 MA and 22 non-Hispanic white [NHW]) were followed. Mean age, NHW-69 (SD 13), MA-66 (SD 11) years, sex (NHW 55% male, MA 50% male) and median presenting National Institutes of Health Stroke Scale did not differ significantly. There were no ethnic differences among the proportion of patients who were sent home without any rehabilitation services (P=0.9). Among those who received rehabilitation, NHWs were more likely to get inpatient rehabilitation (73%) compared with MAs (30%), P=0.016. MAs (51%) were much more likely to 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, whereas NHWs were more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.
BACKGROUND AND PURPOSE: Mexican Americans (MAs) have worse neurological, functional, and cognitive outcomes after stroke. Stroke rehabilitation is important for good outcome. In a population-based study, we sought to determine whether allocation of stroke rehabilitation services differed by ethnicity. METHODS:Patients with stroke were identified as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, TX, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for 3 months after stroke to determine rehabilitation services and transitions. Descriptive statistics were used to depict the study population. Continuous baseline variables were compared using 2 sample t tests or Wilcoxon rank-sum tests by ethnicity. Categorical baseline variables were compared using χ2 tests. Ethnic comparisons of rehabilitation services were compared using χ2 tests, Fisher's exact tests, and logistic regression. RESULTS: Seventy-two subjects (50 MA and 22 non-Hispanic white [NHW]) were followed. Mean age, NHW-69 (SD 13), MA-66 (SD 11) years, sex (NHW 55% male, MA 50% male) and median presenting National Institutes of Health Stroke Scale did not differ significantly. There were no ethnic differences among the proportion of patients who were sent home without any rehabilitation services (P=0.9). Among those who received rehabilitation, NHWs were more likely to get inpatient rehabilitation (73%) compared with MAs (30%), P=0.016. MAs (51%) were much more likely to 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, whereas NHWs were more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.
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