Medha Barbhaiya1, Candace H Feldman2, Hongshu Guan2, Sarah K Chen2, Michael A Fischer3, Daniel H Solomon2, Brendan M Everett4, Karen H Costenbader2. 1. Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, United States. Electronic address: barbhaiyam@hss.edu. 2. Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States. 3. Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, MA, United States. 4. Division of Cardiovascular and Preventive Medicine, Brigham and Women's Hospital, Boston, MA, United States.
Abstract
OBJECTIVE: Systemic lupus erythematosus (SLE), which is associated with increased stroke risk, is more prevalent and often more severe among Blacks, Asians, and Hispanics than Whites. We examined racial/ethnic variation in stroke rates and risks, overall and by hemorrhagic versus ischemic subtype, among SLE patients. METHODS: Within Medicaid (2000-2010), we identified patients aged 18-65 with SLE (≥ 3 ICD-9 710.0 codes, ≥ 30days apart) and ≥12 months of continuous enrollment. Subjects were followed from index date to first stroke event, death, disenrollment, or end of follow-up. Race/ethnicity-specific annual event rates were calculated for stroke overall and by subtypes (hemorrhagic vs. ischemic). We used Cox proportional hazard models to estimate hazard ratios (HR) of stroke by race/ethnicity, adjusting for comorbidities and the competing risk of death. RESULTS: Of 65,788 SLE patients, 93.1% were female. Racial/ethnic breakdown was 42% Black, 38% White, 16% Hispanic, 3% Asian, and 1% American Indian/Alaska Natives. Mean follow-up was 3.7 ± 3.0years. After multivariable adjustment, Blacks were at increased risk of overall stroke (HR 1.34 [95%CI 1.18-1.53), hemorrhagic stroke (HR 1.42 [1.00-2.01]), and ischemic stroke (HR 1.33 [1.15-1.52]) compared to Whites. Hispanics were at increased risk of overall stroke (HR 1.25 [1.06-1.47)] and hemorrhagic stroke (HR 1.79 [95% CI 1.22-2.61]), but not ischemic stroke, compared to Whites. CONCLUSION: Among SLE patients enrolled in Medicaid, we observed elevated stroke risk (overall and by subtype) among Blacks and Hispanics compared to Whites, suggesting the importance of early recognition and screening for stroke risk factors among Blacks and Hispanics.
OBJECTIVE:Systemic lupus erythematosus (SLE), which is associated with increased stroke risk, is more prevalent and often more severe among Blacks, Asians, and Hispanics than Whites. We examined racial/ethnic variation in stroke rates and risks, overall and by hemorrhagic versus ischemic subtype, among SLEpatients. METHODS: Within Medicaid (2000-2010), we identified patients aged 18-65 with SLE (≥ 3 ICD-9 710.0 codes, ≥ 30days apart) and ≥12 months of continuous enrollment. Subjects were followed from index date to first stroke event, death, disenrollment, or end of follow-up. Race/ethnicity-specific annual event rates were calculated for stroke overall and by subtypes (hemorrhagic vs. ischemic). We used Cox proportional hazard models to estimate hazard ratios (HR) of stroke by race/ethnicity, adjusting for comorbidities and the competing risk of death. RESULTS: Of 65,788 SLEpatients, 93.1% were female. Racial/ethnic breakdown was 42% Black, 38% White, 16% Hispanic, 3% Asian, and 1% American Indian/Alaska Natives. Mean follow-up was 3.7 ± 3.0years. After multivariable adjustment, Blacks were at increased risk of overall stroke (HR 1.34 [95%CI 1.18-1.53), hemorrhagic stroke (HR 1.42 [1.00-2.01]), and ischemic stroke (HR 1.33 [1.15-1.52]) compared to Whites. Hispanics were at increased risk of overall stroke (HR 1.25 [1.06-1.47)] and hemorrhagic stroke (HR 1.79 [95% CI 1.22-2.61]), but not ischemic stroke, compared to Whites. CONCLUSION: Among SLEpatients enrolled in Medicaid, we observed elevated stroke risk (overall and by subtype) among Blacks and Hispanics compared to Whites, suggesting the importance of early recognition and screening for stroke risk factors among Blacks and Hispanics.
Authors: Paula I Burgos; Gerald McGwin; Guillermo J Pons-Estel; John D Reveille; Graciela S Alarcón; Luis M Vilá Journal: Ann Rheum Dis Date: 2010-07-13 Impact factor: 19.103
Authors: Dawn O Kleindorfer; Jane Khoury; Charles J Moomaw; Kathleen Alwell; Daniel Woo; Matthew L Flaherty; Pooja Khatri; Opeolu Adeoye; Simona Ferioli; Joseph P Broderick; Brett M Kissela Journal: Stroke Date: 2010-05-20 Impact factor: 7.914
Authors: Hude Quan; Nadia Khan; Brenda R Hemmelgarn; Karen Tu; Guanmin Chen; Norm Campbell; Michael D Hill; William A Ghali; Finlay A McAlister Journal: Hypertension Date: 2009-10-26 Impact factor: 10.190
Authors: Bruce M Psaty; Joseph A Delaney; Alice M Arnold; Lesley H Curtis; Annette L Fitzpatrick; Susan R Heckbert; Barbara McKnight; Diane Ives; John S Gottdiener; Lewis H Kuller; W T Longstreth Journal: Circulation Date: 2015-11-04 Impact factor: 29.690
Authors: Halina White; Bernadette Boden-Albala; Cuiling Wang; Mitchell S V Elkind; Tanja Rundek; Clinton B Wright; Ralph L Sacco Journal: Circulation Date: 2005-03-15 Impact factor: 29.690
Authors: Sarah K Chen; Medha Barbhaiya; Daniel H Solomon; Hongshu Guan; Kazuki Yoshida; Candace H Feldman; Brendan M Everett; Karen H Costenbader Journal: J Rheumatol Date: 2019-11-01 Impact factor: 4.666
Authors: May Y Choi; Daniel Li; Candace H Feldman; Kazuki Yoshida; Hongshu Guan; Seoyoung C Kim; Brendan M Everett; Karen H Costenbader Journal: Rheumatology (Oxford) Date: 2021-08-02 Impact factor: 7.580
Authors: Katherine P Pryor; Medha Barbhaiya; Karen H Costenbader; Candace H Feldman Journal: Rheum Dis Clin North Am Date: 2020-10-29 Impact factor: 2.670
Authors: Teresa Giani; Eve Md Smith; Eslam Al-Abadi; Kate Armon; Kathryn Bailey; Coziana Ciurtin; Joyce Davidson; Janet Gardner-Medwin; Kirsty Haslam; Dan P Hawley; Alice Leahy; Valentina Leone; Flora McErlane; Devesh Mewar; Gita Modgil; Robert Moots; Clarissa Pilkington; Francesca Pregnolato; Athimalaipet V Ramanan; Satyapal Rangaraj; Phil Riley; Arani Sridhar; Nick Wilkinson; Rolando Cimaz; Michael W Beresford; Christian M Hedrich Journal: Lupus Date: 2021-10-02 Impact factor: 2.911