255352 Role of optimism, fatalism, spirituality and depressive symptoms in Mexican American stroke disparities

Monday, October 29, 2012

Lewis Morgenstern, MD , Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI
Brisa N. Sanchez, PhD , Department of Biostatistics, University of Michigan, Ann Arbor, MI
Lesli Skolarus, MD, MS , Stroke Program, Department of Neurology, University of Michigan, Ann Arbor, MI
Jonggyu Baek, MS , Biostatistics, University of Michigan, Ann Arbor, MI
Nelda Garcia, BA , Stroke Program, University of Michigan, Ann Arbor, MI
Jan Risser, PhD , Department of Epidemiology and Disease Control, University of Texas School of Public Health, Houston, TX
Melinda Smith, DrPh , Stroke Program, University of Michigan, Ann Arbor, MI
Darin Zahuranec, MD , Stroke Program, University of Michigan, Ann Arbor, MI
Kevin Kerber, MD MS , Stroke Program, University of Michigan, Ann Arbor, MI
Lynda Lisabeth, PhD , Stroke Program, University of Michigan, Ann Arbor, MI
  
Background and Objective: Stroke disparities among Mexican Americans (MAs) and non Hispanic whites (NHWs) are pervasive. In a population-based study we used validated scales to query patients soon after stroke about their pre-stroke optimism, pessimism, spirituality and depressive symptoms (“factors”) and related these to stroke outcome. Methods: Using active and passive surveillance, all stroke patients in Nueces County, Texas, June 2004-December 2008 were invited to participate. Patients with aphasia and severe stroke were excluded using pre-specified criteria. Standardized, validated scales were available in Spanish or English. Outcome measures included initial stroke severity using chart abstracted NIH stroke scale (NIHSS), stroke recurrence and all-cause mortality. The crude and confounder adjusted associations between ethnicity and stroke outcome were investigated using multiple linear regression with log-transformed NIHSS as the dependent variable and Cox proportional hazards regression for time to recurrence or mortality. Effect modification terms between the factors and ethnicity were also examined. Results: There were 669 participants, 54% MA and 46% NHW. MA ethnicity was associated with a lower mortality rate (HR=0.63, 95%CI: 0.42, 0.95), a higher recurrence rate (HR=1.74, 95%CI: 1.07, 2.83), and non-significant difference in severity (4% higher NIHSS, 95%CI: -11%, 22%). After adjustment for the factors individually, the MA-outcome associations changed by less than 4%. A suggestion of effect modification by optimism and depression on stroke recurrence was present. Conclusion: Optimism, pessimism, spirituality and depressive symptoms are unlikely to explain the robust MA-NHW stroke disparities. The possible modification of the association of ethnicity and stroke recurrence by depressive symptoms and optimism warrants further attention.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Epidemiology
Public health or related research
Social and behavioral sciences

Learning Objectives:
Define the role of optimism, fatalism, spirituality and depressive symptoms in explaining the Mexican American-non Hispanic white stroke disparity. Explain the effect modification of depressive symptoms and optimism with ethnicity for stroke recurrence.

Keywords: Ethnic Minorities, Strokes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Study PI of NIH funded study for this work, wrote the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3281.1: Health Disparities Poster Session