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Multiple Chronic Conditions Explain Ethnic Differences in Functional Outcome Among Patients With Ischemic Stroke
Stroke ( IF 8.3 ) Pub Date : 2021-09-14 , DOI: 10.1161/strokeaha.120.032595 Xiaqing Jiang 1 , Lewis B Morgenstern 1, 2 , Christine T Cigolle 3, 4 , Lu Wang 5 , Edward S Claflin 2, 6 , Lynda D Lisabeth 1, 2
Stroke ( IF 8.3 ) Pub Date : 2021-09-14 , DOI: 10.1161/strokeaha.120.032595 Xiaqing Jiang 1 , Lewis B Morgenstern 1, 2 , Christine T Cigolle 3, 4 , Lu Wang 5 , Edward S Claflin 2, 6 , Lynda D Lisabeth 1, 2
Affiliation
Background and Purpose:Mexican Americans (MAs) have worse stroke outcomes and a different profile of multiple chronic conditions (MCC) compared with non-Hispanic White people. MCC has implications for stroke treatment, complications, and poststroke care, which impact poststroke functional outcome (FO). We sought to assess the contribution of MCC to the ethnic difference in FO at 90 days between MAs and non-Hispanic White people.Methods:In a prospective cohort of ischemic stroke patients (2008–2016) from Nueces County, Texas, data were collected from patient interviews, medical records, and hospital discharge data. MCC was assessed using a stroke-specific and function-relevant index (range, 0–35; higher scores greater MCC burden). Poststroke FO was measured by an average score of 22 activities of daily living (ADLs) and instrumental ADLs at 90 days (range, 1–4; higher scores worse FO). The contribution of MCC to the ethnic difference in FO was assessed using Tobit regression. Effect modification by ethnicity was examined.Results:Among the 896 patients, 70% were MA and 51% were women. Mean age was 68±12.2 years; 33% of patients were dependent in ADL/instrumental ADLs (FO score >3, representing a lot of difficulty with ADL/instrumental ADLs) at 90 days. MAs had significantly higher age-adjusted MCC burden compared with non-Hispanic White people. Patients with high MCC score (at the 75th percentile) on average scored 0.70 points higher in the FO score (indicating worse FO) compared with those with low MCC score (at the 25th percentile) after adjusting for age, initial National Institutes of Health Stroke Scale, and sociodemographic factors. MCC explained 19% of the ethnic difference in FO, while effect modification by ethnicity was not statistically significant.Conclusions:MAs had a higher age-adjusted MCC burden, which partially explained the ethnic difference in FO. The prevention and treatment of MCC could potentially mitigate poststroke functional impairment and lessen ethnic disparities in stroke outcomes.
中文翻译:
多种慢性疾病解释了缺血性中风患者功能结果的种族差异
背景和目的:与非西班牙裔白人相比,墨西哥裔美国人 (MAs) 的卒中结局更差,多种慢性病 (MCC) 的情况也不同。MCC 对中风治疗、并发症和中风后护理有影响,这会影响中风后功能结果 (FO)。我们试图评估 MCC 对 MAs 和非西班牙裔白人之间 90 天 FO 种族差异的贡献。方法:在来自德克萨斯州纽埃斯县的缺血性卒中患者(2008-2016 年)的前瞻性队列中,收集了数据来自患者访谈、医疗记录和出院数据。使用卒中特异性和功能相关指数(范围,0-35;分数越高,MCC 负担越大)评估 MCC。卒中后 FO 是通过 90 天时 22 项日常生活活动 (ADL) 和仪器 ADL 的平均得分来衡量的(范围,1-4;分数越高,FO 越差)。使用 Tobit 回归评估 MCC 对 FO 种族差异的贡献。检查了种族的影响修正。结果:在 896 名患者中,70% 为 MA,51% 为女性。平均年龄为 68±12.2 岁;33% 的患者在 90 天时依赖于 ADL/工具性 ADL(FO 评分 >3,代表 ADL/工具性 ADL 有很多困难)。与非西班牙裔白人相比,MA 的年龄调整后 MCC 负担明显更高。调整年龄后,与 MCC 评分较低(第 25 个百分位)的患者相比,MCC 评分较高的患者(第 75 个百分位)的 FO 评分(表示更差的 FO)平均得分高 0.70 分,最初的美国国立卫生研究院卒中量表和社会人口因素。MCC 解释了 19% 的 FO 种族差异,而种族影响的修正在统计学上不显着。结论:MAs 具有较高的年龄调整 MCC 负担,这部分解释了 FO 的种族差异。MCC 的预防和治疗可能会减轻卒中后功能障碍,并减少卒中结局的种族差异。
更新日期:2021-09-14
中文翻译:
多种慢性疾病解释了缺血性中风患者功能结果的种族差异
背景和目的:与非西班牙裔白人相比,墨西哥裔美国人 (MAs) 的卒中结局更差,多种慢性病 (MCC) 的情况也不同。MCC 对中风治疗、并发症和中风后护理有影响,这会影响中风后功能结果 (FO)。我们试图评估 MCC 对 MAs 和非西班牙裔白人之间 90 天 FO 种族差异的贡献。方法:在来自德克萨斯州纽埃斯县的缺血性卒中患者(2008-2016 年)的前瞻性队列中,收集了数据来自患者访谈、医疗记录和出院数据。使用卒中特异性和功能相关指数(范围,0-35;分数越高,MCC 负担越大)评估 MCC。卒中后 FO 是通过 90 天时 22 项日常生活活动 (ADL) 和仪器 ADL 的平均得分来衡量的(范围,1-4;分数越高,FO 越差)。使用 Tobit 回归评估 MCC 对 FO 种族差异的贡献。检查了种族的影响修正。结果:在 896 名患者中,70% 为 MA,51% 为女性。平均年龄为 68±12.2 岁;33% 的患者在 90 天时依赖于 ADL/工具性 ADL(FO 评分 >3,代表 ADL/工具性 ADL 有很多困难)。与非西班牙裔白人相比,MA 的年龄调整后 MCC 负担明显更高。调整年龄后,与 MCC 评分较低(第 25 个百分位)的患者相比,MCC 评分较高的患者(第 75 个百分位)的 FO 评分(表示更差的 FO)平均得分高 0.70 分,最初的美国国立卫生研究院卒中量表和社会人口因素。MCC 解释了 19% 的 FO 种族差异,而种族影响的修正在统计学上不显着。结论:MAs 具有较高的年龄调整 MCC 负担,这部分解释了 FO 的种族差异。MCC 的预防和治疗可能会减轻卒中后功能障碍,并减少卒中结局的种族差异。