LOS ANGELES—Mexican Americans with midlife stroke may have significantly worse 90-day outcomes, compared with non-Hispanic whites, according to a study presented at the International Stroke Conference 2018. Mexican Americans had lower physical quality of life scores and a high prevalence of depression, the authors noted.
“The growing number of midlife stroke survivors will have unique rehabilitation and health care resource needs,” said Lynda D. Lisabeth, PhD, MPH, Professor of Epidemiology at the University of Michigan Medical School in Ann Arbor. “Particular attention to Mexican American midlife stroke survivors is warranted.”
Midlife stroke can result in many years of stroke-related disability, and midlife stroke rates are stable or increasing. The impact of midlife stroke may be worse in Mexican Americans, who have higher stroke rates, earlier strokes, and appear to have worse outcomes, said the researchers. To compare stroke outcomes in Mexican Americans and non-Hispanic whites younger than 65, Dr. Lisabeth and colleagues analyzed data from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project in South Texas.
The researchers identified patients younger than 65 with incident ischemic stroke between 2008 and 2015. Strokes were identified using active and passive stroke surveillance and validated by a physician blinded to patients’ ethnicity. Investigators conducted in-person interviews with patients or proxies at baseline and at 90 days. The researchers assessed patients’ functional, neurologic, and cognitive outcomes, quality of life, and depression.
Of 925 patients with a first ischemic stroke between the ages of 45 and 64, 508 patients had outcome data (341 Mexican Americans and 167 non-Hispanic whites). At baseline, Mexican Americans had lower levels of education, higher average BMI, and were more likely to have hypertension and diabetes, compared with non-Hispanic whites. Mexican Americans were less likely to smoke than non-Hispanic whites, however.
After adjusting for confounders (eg, age, sex, education, insurance, marital status, stroke severity, stroke treatment, risk factors, prestroke function, cognition, and comorbidity level), Mexican Americans had significantly worse 90-day outcomes than non-Hispanic whites in every domain except depression. Among Mexican Americans, the median functional outcome score (ie, total Activities of Daily Living/Instrumental Activities of Daily Living score, range 1–4, higher scores worse) was 1.9, compared with 1.5 among non-Hispanic whites (adjusted mean difference, 0.26). The median NIH Stroke Scale score (range 0–42, higher scores worse) was 2 among Mexican Americans, compared with 1 among non-Hispanic whites (adjusted mean difference, 26%).
In addition, the median score on the Modified Mini-Mental State Examination (range 0–100, higher scores better) was 90 for Mexican Americans, compared with 94.5 for non-Hispanic whites. Mexican Americans had a lower median total Stroke-Specific Quality of Life score (range 1–5, higher scores better) and lower median scores on the physical and psychosocial Stroke-Specific Quality of Life subscales, compared with non-Hispanic whites (3.3 vs 3.8, 2.5 vs 3.2, and 4.2 vs 4.5, respectively). In addition, a greater percentage of Mexican Americans had depression, compared with non-Hispanic whites (41.1% vs 34.5%), but this difference was not significant, likely due to the smaller sample size for this outcome.