Blacks hospitalized for acute ischemic stroke received more aggressive treatment and had significantly lower mortality rates than whites, study results published in Annals of Internal Medicine indicate.
“These results fly in the face of conventional wisdom that says that black patients with strokes have worse outcomes,” study researcher Robert Holloway, MD, MPH, and neurologist at University of Rochester Medical Center, said in a press release.
Holloway and colleagues analyzed data from 5,319 non-Hispanic blacks and 18,340 whites aged 18 years and older admitted to New York hospitals with acute ischemic stroke in 2005 and 2006. Data were collected from the New York State Statewide Planning and Research Cooperative system, which contains detailed information on every statewide hospital and ED admission.
The researchers found that overall in-hospital mortality was lower for black patients compared with white patients (5.0% vs. 7.45; P<.001), as well as 30-day (6.1% vs. 11.4%; P<.001) and one year all-cause mortality (16.5% vs. 24.4%; P<.001). The association between race and mortality rates remained even after adjusting for age, socioeconomic status and other risk factors.
Additional data revealed that black patients were more likely to receive a life-sustaining intervention than white patients (OR=1.22; 95% CI: 1.09-1.38), but less likely to be discharged to hospice (OR=0.25; 95% CI: 0.14-0.46).
“Even though we do not know the exact reasons for these differences, these data highlight the potential importance of treatment intensity and the expression of patient preference for different treatments on survival and mortality,” Holloway said.
Information was not available to differentiate whether care decisions were made on the basis of expressed intent, do not resuscitate orders, health care proxies, living wills or family members deciding on behalf of the patients.
Also, the researchers were unable to measure quality of life among stroke survivors, which Holloway called “a critically important question.”
Study researcher Ying Xian, MD, PhD, a former graduate student at University of Rochester and current fellow at Duke Clinical Research Institute in Durham, N.C., emphasized that mortality is not the only measure that health care providers should be concerned about.
“Even though people who receive aggressive life-sustaining care have lower mortality it does not mean they have better quality of care or quality of life,” Xian said.
More research is needed to better understand patients’ decision-making processes and to determine if the treatments patients receive are ethical, according to the researchers.