Background: Evidence suggests that racial and ethnic minorities consistently have poorer post-stroke functional outcomes.
Hypothesis: We hypothesized that race in addition to socioeconomic status (SES) would correlate with poorer measures of functional outcomes in stroke patients.
Methods: Our aim was to identify factors that contribute to disparate functional outcomes among middle- and retirement-aged non-Hispanic whites (white) and non-Hispanic African Americans (AA). Through retrospective analysis of data from the Health and Retirement Study (HRS), we analyzed 2,831 respondents who reported incident stroke between 1999 and 2014. Respondents were asked to report perceived difficulty with gross and fine motor function and basic activities of daily living (ADL). Linear and logistic regression analysis determined independent predictors of post-stroke motor function and ADL.
Results: The analysis included 2,314 (82%) whites and 517 (18%) AA adults with stroke. The AA median age was 71± 11.3 while the white median age was 76 ± 10.5 (p<0.0001). Factors associated with more difficulty with ADL, fine motor function, and gross motor function included older age, female gender, AA race, and higher numbers of household residents. Surprisingly, the comorbidity score was only associated with difficulty in gross motor function. Moreover, the time since stroke did not associate with any performance measure. Increased difficulty with performance-based ADL, fine, and gross motor skills in AAs relative to whites, was associated with younger age, more residents in the home, and less household income. Although our analysis was limited due to the lack of long-term follow-up in the HRS study, these data can help direct future stroke recovery health disparity studies.
Conclusions: Our findings highlight the importance of examining contributing factors to racial disparities in post stroke outcomes.