Background: National data shows that African Americans (AA) are less likely to fall than whites. However, the reasons for this difference and whether it is true amongst stroke survivors are unknown. We hypothesized that AA stroke survivors fall less than white stroke survivors, and sought to understand which risk factors drive racial differences.
Methods: Data from the 2011 wave of National Health and Aging Trends Study (NHATs), a nationally representative population of community-dwelling adults over 65, were used. We compared the prevalence of self-reported falling in the past year between AA and white stroke survivors using Poisson regression models. Models were adjusted for groups of variables that may predict race-based differences in falls: sociodemographic, comorbidity, capacity, fall risk factor, fall access, and environment. Race-specific predictive margins and prevalence ratios (PR) were calculated.
Results: The sample included 806 stroke survivors; 581 white and 228 AA. AAs had lower income, physical and cognitive capacity, were less likely to be married, to go outside, to have osteoporosis, and lived in worse neighborhood environments compared to white stroke survivors. Unadjusted, prevalence of falling in the past year was similar comparing AA to whites (PR: 0.89, p=0.2). Adjustment for sociodemographic variables produced a marginal racial difference, which became statistically significant after adding physical and cognitive capacity measures (Table). After full adjustment, AA were 30% less likely to have reported a fall compared to whites (p=0.004).
Conclusions: African American stroke survivors are significantly less likely to report falling in the previous year compared to whites. Differences in sociodemographics and capacity may be most influential, yet other factors did not account for differences in fall prevalence. Further study of falls among AA stroke survivors may provide insight to decrease falls among other racial/ethnic groups.