Race/Ethnic Disparities for In-Hospital Mortality and Disability at Discharge after Acute Ischemic Stroke: Florida Puerto Rico Collaboration to Reduce Stroke Disparities (P5.287)

Objective: To identify race/ethnicity differences for in-hospital mortality and disability at discharge after acute ischemic stroke (AIS) in patients admitted to Florida hospitals participating in the Florida Collaboration to Reduce Stroke Disparities. (CReSD). Background: Studies suggest differences in stroke care associated with race/ethnicity and describe a higher mortality rate in minority stroke patients. We sought to investigate race-ethnic disparities for in-hospital stroke mortality and disability after stroke. Design/Methods: In-hospital mortality was analyzed in 75,077 AIS cases from 69 FL hospitals participating in the AHA Get With the Guidelines-Stroke Program and FL-PR CReSD Stroke Registry. Patients were stratified into 3 groups based on race/ethnicity: white (67%), black (19%) and Hispanic (14%). Disability at discharge was evaluated by Modified Rankin Score (mRs) in 19,052 cases, and dichotomized in mild (mRs ≤ 2) and severe (mRs 3–5). Multivariable logistic regression models were used to test the relationship between race/ethnicity and mortality and disability after adjusting for age, sex, and other confounding factors [smoking status, cardio-vascular risk factors, stroke severity, insurance status, mode of arrival, pre-stroke ambulation and hospital’s academic status]. Results: In our AIS population, mean age was 70.8 (±14.4) and 49.5% were women. In-hospital mortality was observed in 4% of cases (4% white, 3% black and 4% Hispanic). After adjustments, lower mortality was observed among blacks in comparison to whites [OR=0.84, 95% CI 0.7–1.0]. Overall 52% of cases were severely disabled at discharge (52% white, 51% black and 53% Hispanic). In adjusted models, blacks were more likely to have mRs 3–5 compared to whites [OR=1.33, 95% CI 1.2–1.49]. Conclusions: In our large Florida Stroke Registry, we observed lower in-hospital mortality, but greater disability at discharge after stroke among blacks in comparison to whites. This paradox needs further exploration to design and implement interventions to improve stroke outcome and reduce disparities in post-stroke disability. Disclosure: Dr. Simonetto has nothing to disclose. Dr. Gardener has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Gutierrez has nothing to disclose. Dr. Ciliberti has nothing to disclose. Dr. Dong has nothing to disclose. Dr. Foster has nothing to disclose. Dr. Waddy has nothing to disclose. Dr. Romano has received personal compensation for activities with NovaVision as an advisory board member and consultant. Dr. Rundek has nothing to disclose. Dr. Sacco has received research support from Boehringer Ingelheim Pharmaceuticals.