Neurological, Functional, and Cognitive Stroke Outcomes in Mexican Americans

• Published in: Stroke (1970) Vol. 45; no. 4; pp. 1096 - 1101
• Main Authors: Lisabeth, Lynda D., Sánchez, Brisa N., Baek, Jonggyu, Skolarus, Lesli E., Smith, Melinda A., Garcia, Nelda, Brown, Devin L., Morgenstern, Lewis B.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01.04.2014; Lippincott Williams & Wilkins
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Biological and medical sciences; Cognition Disorders - ethnology; Cognition Disorders - mortality; Cognition Disorders - physiopathology; Dementia - ethnology; Dementia - mortality; Dementia - physiopathology; Disability Evaluation; European Continental Ancestry Group - statistics & numerical data; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Mexican Americans - statistics & numerical data; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Neuropsychological Tests; Recovery of Function - physiology; Risk Factors; Stroke - ethnology; Stroke - mortality; Stroke - physiopathology; Texas - epidemiology; Vascular diseases and vascular malformations of the nervous system; Texas; Vascular disease; Human; Stroke; Nervous system diseases; Prognosis; ethnicity; Central nervous system disease; Cardiovascular disease; Cerebrovascular disease; patient outcome assessment; Cerebral disorder; stroke
• DOI: 10.1161/STROKEAHA.113.003912
• ISSN: 0039-2499; 1524-4628

BACKGROUND AND PURPOSE—Our objective was to compare neurological, functional, and cognitive stroke outcomes in Mexican Americans (MAs) and non-Hispanic whites using data from a population-based study. METHODS—Ischemic strokes (2008–2012) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Data were collected from patient or proxy interviews (conducted at baseline and 90 days poststroke) and medical records. Ethnic differences in neurological (National Institutes of Health Stroke Scalerange, 0–44; higher scores worse), functional (activities of daily living/instrumental activities of daily living scorerange, 1–4; higher scores worse), and cognitive (Modified Mini-Mental State Examinationrange, 0–100; lower scores worse) outcomes were assessed with Tobit or linear regression adjusted for demographics and clinical factors. RESULTS—A total of 513, 510, and 415 subjects had complete data for neurological, functional, and cognitive outcomes and covariates, respectively. Median age was 66 (interquartile range, 57–78); 64% were MAs. In MAs, median National Institutes of Health Stroke Scale, activities of daily living/instrumental activities of daily living, and Modified Mini-Mental State Examination score were 3 (interquartile range, 1–6), 2.5 (interquartile range, 1.6–3.5), and 88 (interquartile range, 76–94), respectively. MAs scored 48% worse (95% CI, 23%–78%) on National Institutes of Health Stroke Scale, 0.36 points worse (95% CI, 0.16–0.57) on activities of daily living/instrumental activities of daily living score, and 3.39 points worse (95% CI, 0.35–6.43) on Modified Mini-Mental State Examination than non-Hispanic whites after multivariable adjustment. CONCLUSIONS—MAs scored worse than non-Hispanic whites on all outcomes after adjustment for confounding factors; differences were only partially explained by ethnic differences in survival. These findings in combination with the increased stroke risk in MAs suggest that the public health burden of stroke in this growing population is substantial.