African American women have poor long-term survival following ischemic stroke

OBJECTIVE: To determine racial and gender differences in long-term survival following ischemic stroke in a well-defined cohort of patients. METHODS: We analyzed the prospectively collected data from a randomized, placebo-controlled trial in patients with ischemic stroke presenting within 3 hours of symptom onset. We determined the effect of race and gender on 1-year survival ascertained by serial follow-ups using Kaplan-Meier analysis. Multivariate analysis was performed adjusting for age, initial NIH Stroke Scale (NIHSS) score, use of thrombolysis, time to randomization, stroke etiology, and other cardiovascular risk factors. RESULTS: Of the 547 patients with ischemic stroke, the 1-year survival (percentage ± SE) for African American women (63 ± 6%) was lower than white women (73 ± 4%), African American men (79 ± 4%), and white men (75 ± 3%). Among the 209 patients younger than 65 years, the 1-year survival was prominently lower for African American women (66 ± 8%) vs white women (87 ± 5%), African American men (83 ± 5%), and white men (89 ± 3%). In the Cox proportional hazard analysis, African American women had a significantly higher rate of 1-year mortality (relative risk 2.1, 95% CI 1.2 to 3.5) after adjusting for all potential confounders except diabetes mellitus. After adjustment for diabetes mellitus, the difference became insignificant, although a 70% greater risk of 1-year mortality was still observed. CONCLUSIONS: Compared with whites and men, African American women have a lower 1-year survival following ischemic stroke.