Stroke outcomes worse for Mexican Americans

At 90 days after stroke, Mexican-American patients scored worse than non-Hispanic white patients on neurological, functional and cognitive stroke outcomes.

The differences remained after adjustment for confounding factors and were explained only in part by ethnic differences in survival.

Researchers analyzed data from the Brain Attack Surveillance on Corpus Christi (BASIC) Project, a population-based stroke surveillance study in Nueces County, Texas. All participants (median age, 66 years; 64% Mexican American) had ischemic stroke between 2008 and 2012. Complete neurological and covariate data were available for 513 participants, complete functional and covariate data for 510 participants, and complete cognitive and covariate data for 415 participants. Neurological outcomes were assessed by the NIH Stroke Scale, functional outcomes by the activities of daily living/instrumental activities of daily living score, and cognitive outcomes by the Modified Mini-Mental State Examination.

After multivariable adjustment, Mexican-American patients scored 48% lower on the NIH Stroke Scale (95% CI, 23-78), 0.36 lower on the daily living/instrumental activities of daily living score (95% CI, 0.16-0.57) and 3.39 points lower on the Modified Mini-Mental State Examination (95% CI, 0.35-6.43) compared with non-Hispanic whites.

The median NIH Stroke Scale score was 3 (interquartile range, 1-6) for Mexican-American patients compared with 2 (interquartile range, 0-4) for non-Hispanic white patients. The median daily living/instrumental activities of daily living score was 2.5 (interquartile range, 1.6-3.5) for Mexican-American patients compared with 2.1 (interquartile range, 1.2-3) for non-Hispanic white patients. The median Modified Mini-Mental State Examination score in those without language dysfunction was 88 (interquartile range, 76-94) in Mexican-American patients compared with 92 (interquartile range, 79-96) in non-Hispanic white patients.

Previous research showed that Mexican Americans have increased risk for stroke, but lower stroke mortality rates and longer poststroke survival compared with non-Hispanic whites, according to the study background.

“Our current results suggest that this prolonged survival is at the expense of poor outcomes because [Mexican-American] stroke survivors experienced poorer neurological, functional, and cognitive outcomes than [non-Hispanic whites] even after adjustment for a comprehensive list of factors,” Lynda D. Lisabeth, PhD, from the University of Michigan School of Public Health, and colleagues wrote. “Differential mortality by ethnicity explained some but not all of the ethnic differences in outcomes, suggesting that research on the causes of poorer outcomes in [Mexican Americans] compared with that of [non-Hispanic whites] is warranted.”

Disclosure: The researchers report no relevant financial disclosures.