Stroke survival better for African Americans
NEW YORK (Reuters Health) - Despite facing a greater risk of stroke, African Americans may have better survival rates than whites in the first year after the event, a study published Monday suggests.
The findings are surprising, researchers say, because black stroke patients are generally thought to have worse outcomes.
"Based on mortality rates, we found the exact opposite," said Dr. Robert G. Holloway, a neurologist at the University of Rochester Medical Center in New York and one of the researchers on the study.
He and his colleagues found that among more than 23,000 stroke patients treated at New York State hospitals over two years, six percent of African Americans died within one month, versus 11 percent of white patients.
After one year, 16.5 percent of black patients had died, compared with just over 24 percent of whites.
Even with other factors taken into account -- like age and other medical conditions -- African Americans had a lower risk of dying in the first year, the researchers report in the Annals of Internal Medicine.
The reasons for the racial gap are not clear, Holloway told Reuters Health.
But he said the results point to one potential explanation: African Americans were more likely than whites to receive aggressive, life-sustaining measures -- like being placed on a ventilator if they could not breathe on their own, receiving dialysis when their kidneys failed, or getting CPR if they went into cardiac arrest.
Just over 15 percent of black patients received some form of life-sustaining measure, compared with just under 13 percent of white patients.
"That doesn't prove a causal relationship," Holloway said. "But I think this tells us that we have to take a look at how life-sustaining interventions may play a role in this."
But even if more-aggressive care plays a part in African Americans' higher short-term survival, it does not mean that aggressive is always better, according to Holloway.
Depending on the amount and type of brain damage, strokes can leave people severely disabled. The current study looked only at short-term survival rates, and not at patients' ability to function or their quality of life.
"The critical question is, what is the quality of life for these patients?" Holloway said.
The findings are based on 5,319 African-American and 18,340 white patients treated for a stroke at any of 164 New York hospitals from 2005 through 2006.
While black patients had a higher rate of aggressive, life-sustaining care, white patients were more likely to go into hospice care -- just over two percent did, versus 0.5 percent of African Americans.
Hospice care focuses on easing symptoms and improving quality of life for people who are terminally ill.
There's no way to tell why black patients more often received life-prolonging treatments. But past studies have found that African Americans are more likely than whites to want such measures, Holloway said.
Studies have also shown that African Americans are less likely than whites to have documented plans in place for their end-of-life care -- like living wills, which spell out the types of treatments you do or do not want in the event that you are too ill to make those decisions. Without those documents, family members are left to make the choice on their own.
Holloway said that future studies need to look at the "quality" of treatment decision-making -- including how doctors communicate with patients and families.
"How well," Holloway said, "is the physician communicating and hearing and understanding the patient's and family's preferences?"
SOURCE: bit.ly/an7XRm Annals of Internal Medicine, online February 1, 2011.
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