DISCLOSURE INFORMATION (relative only): Eric D. Peterson, PI of the AHA GWTG Data Analysis Center; Lee H. Schwamm, Chair of the AHA National Steering Committee for GWTG (unpaid)

• The racial disparity in stroke is an enormous public concern

• Despite higher burden of stroke in minorities, limited data exists in comparing

mortality for patients with intracerebral hemorrhage of different racial and

ethnic backgrounds

Background

Methods

• Data from 123,736 patients with intracerebral hemorrhage admitted to 1,199

Get With The Guidelines-Stroke (GWTG) hospitals between 2003-2012

• Multivariate logistic regressions with generalized estimating equations were

performed to evaluate the association between race and in-hospital mortality

• We adjusted for patient-level characteristics including age, gender, and

medical history, as well as hospital-level characteristics including region,

hospital type, size, primary stroke center status, percentage of minority

patients treated, number of ICH admissions per year, and calendar time

• Sensitivity analyses among patients with complete National Institutes of

Health Stroke Scale score (NIHSS)

• To determine whether racial/ethnic differences in mortality varied by age, we

further examined the interaction between age and race

Results

Racial/Ethnic Differences in Mortality among Patients Hospitalized with Intracerebral Hemorrhage Ying Xian,

1 Robert G. Holloway,

2 Eric E. Smith,

3 Lee H. Schwamm,

4 Mathew J. Reeves,

5 Margueritte Cox,

1 DaiWai M. Olson,

1

Adrian F. Hernandez,1

Barbara Lytle,1

Gregg C. Fonarow,6 Eric D. Peterson,

1

1Duke Clinical Research Institute, Durham, NC;

2University of Rochester, Rochester, NY;

3Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada;

4Department of Neurology, Massachusetts General Hospital, Boston, MA;

5Department of Epidemiology, Michigan State University, East Lansing, MI;

6Division of Cardiology, University of California, Los Angeles, CA

Table 1. Baseline Characteristics by Race Table 2. In-hospital Mortality by Race

Conclusions• Among patients hospitalized with intracerebral hemorrhage, black, Hispanic, and other racial/ethnic groups have lower risk-adjusted in-hospital mortality compared

to white patients, though these racial/ethnic differences were largely confined to patients age 60 years and older

FUNDING STATEMENT: The Get With The Guidelines®–Stroke (GWTG-Stroke) program is provided by the American Heart Association/American Stroke Association. The GWTG-Stroke program is currently supported in part by a charitable contribution from Janssen Pharmaceutical Companies of Johnson & Johnson. GWTG-Stroke has been funded in the past through support from Boeringher-Ingelheim, Merck, Bristol-Myers Squib/Sanofi Pharmaceutical Partnership

and the AHA Pharmaceutical Roundtable.

Variable White N=83,280 (%)

Black N=22,165 (%)

Hispanic N=10,541 (%)

Other N=7,750 (%)

P value

Patient characteristicsAge, median (IQR) 75 (63-83) 59 (51-71) 64 (52-77) 67 (56-79) <.001Female 50 49 42 47 <.001Medical history Atrial Fibrillation/Flutter 20 6 8 12 <.001 Previous stroke TIA 26 24 23 25 <.001 CAD/prior MI 25 13 16 14 <.001 Carotid stenosis 3 1 1 1 <.001 Diabetes mellitus 23 29 35 29 <.001 PVD 4 2 2 1 <.001 Hypertension 75 86 78 79 <.001 Smoker 13 24 13 9 <.001 Dyslipidemia 34 20 26 30 <.001 Heart failure 5 5 4 3 <.001NIHSS, median (IQR) 9 (3-19) 10 (4-19) 10 (4-20) 11 (4-11) <.001Hospital characteristicsAcademic 57 70 54 60 <.001Primary stroke center 57 50 52 55 <.001# of beds, median (IQR) 391 (274-546) 460 (339-690) 381 (296-565) 365 (262-478) <.001# of ICH admission per year

46 (25-79) 55 (31-89) 48 (28-80) 50 (32-83) <.001

Percent of minority, % median IQR

16 (8-29) 41 (26-62) 46 (27-67) 39 (22-62) <.001

Age category Race/ethnicity comparison

In-hospital mortality, %

Adjusted OR (95% CI)

Further adjustment for NIHSS (95 %CI)

Overall Black vs. white 22.8 vs. 27.4 0.91 (0.87-0.95) 0.79 (0.72-0.87)Hispanic vs. white 22.7 vs. 27.4 0.85 (0.79-0.91) 0.73 (0.65-0.82)Others vs. white 25.2 vs. 27.4 0.87 (0.81-0.93) 0.67 (0.59-0.76)

<50 Black vs. white 22.1 vs. 21.5 1.05 (0.95-1.16) 0.87 (0.69-1.10)Hispanic vs. white 21.1 vs. 21.5 0.96 (0.83-1.11) 0.80 (0.59-1.07)Others vs. white 21.5 vs. 21.5 0.94 (0.77-1.14) 0.69 (0.46-1.03)

50-59 Black vs. white 22.6 vs. 23.2 0.99 (0.91-1.08) 0.89 (0.75-1.06)Hispanic vs. white 22.8 vs. 23.2 0.95 (0.84-1.08) 0.83 (0.68-1.02)Others vs. white 22.4 vs. 23.2 0.85 (0.72-1.00) 0.59 (0.42-0.81)

60-74 Black vs. white 21.6 vs. 25.2 0.86 (0.79-0.93) 0.72 (0.62-0.84)Hispanic vs. white 21.9 vs. 25.2 0.85 (0.76-0.95) 0.74 (0.61-0.90)Others vs. white 23.1 vs. 25.2 0.82 (0.73-0.91) 0.61 (0.51-0.74)

>74 Black vs. white 25.5 vs. 30.5 0.82 (0.75-0.89) 0.74 (0.63-0.88)Hispanic vs. white 24.5 vs. 30.5 0.75 (0.67-0.83) 0.66 (0.64-0.79)Others vs. white 30.4 vs. 30.5 0.93 (0.83-1.05) 0.78 (0.64-0.93)

• Compared with white patients, black, Hispanic, and other race were younger

• Minorities had less comorbidities except for diabetes mellitus and hypertension, and had more severe stroke as documented by NIHSS

• Black, Hispanic, and other racial/ethnic patients were less likely to die in-hospital than white patients after adjustment for patient and hospital characteristics. The

mortality differences remained consistent after further adjustment for NIHSS in NIHSS complete records

• After examining age and race interaction, the mortality difference was observed in older age groups, but was not evident in younger age groups

• In contrast to lower mortality, minorities had longer length of stay than white patients (median 6, 6, 6, and 5 days for black, Hispanic, other, and white, respectively,

p<.001)