Stroke Rates Decline Yet Burden of Stroke Remains High for African Americans

Objective: Examine race variation in the burden of stroke and associated risk factors among hospital-discharged patients.  Methods: We examined Tennessee Hospital Discharge Data from 1997-2008 for discharged patients with a primary diagnosis of stroke along with their cardiovascular risk factors (nearly 17,000 patients per year). Age-adjusted prevalence of hospitalization for stroke per 100K for white and African American patient groups was developed per CDC procedures of at risk population. Race specific prevalence of stroke and associated risk factors were examined using multivariate logistic models. To examine consistency, we compared the two groups at three different points: 1997, 2003, and 2008 regarding the prevalence of stroke and their associated risk factors. Results: Our analyses of hospitalized stroke patients revealed three major trends: (1) stroke rate declined by 13.8% over a 12-year period (from 466.8 per 100K in 1997 to 402.2 per 100K in 2008); this decline occurred for both black and white patients; (2) the stroke rates among African Americans remained consistently higher compared to whites (African American-white rate ratios of 1.60 in 1997, 1.40 in 2003, and 1.60 in 2008); and (3) four risk factors consistently predicted stroke for both African American and white patients at three points of comparison, namely, hypertension, diabetes, high cholesterol, and cardiac arrhythmia. Conclusion: Aggressive management of two cardiovascular risk factors (Hypertension and Diabetes) may subsequently reduce the burden of stroke hospitalization among African Americans.