Race-Ethnic In Stroke Type And Outcome Among Hyperacute Cerebrovascular Disease Patients.

Background: Prior studies have suggested race-ethnic differences in functional outcome, mortality, and use of comfort care after stroke, but have been limited by analysis of single stroke subtypes, lack of 3-month outcomes, and uncertainty whether delayed access to acute care was moderating response patterns. Methods: We analyzed all patients with final diagnoses of acute cerebral ischemia or intracranial hemorrhage enrolled within 2 hours of onset in the multicenter, prehospital NIH FAST-MAG trial. Self- or family-reported race-ethnicity was analyzed for relation to presenting stroke features, stroke subtype, and 3-month outcome. Results: Among 1616 hyperacute cerebrovascular disease patients (76.4% acute cerebral ischemia, 23.6% intracranial hemorrhage), race-ethnic frequencies were: white, non-Hispanic (W) - 55.5%, Hispanic (H) - 23.1%, Black (B) - 13.6%, Asian (A) - 8.4%. Ischemic vs hemorrhagic stroke differed by race-ethnicity, with hemorrhagic strokes more common in Hispanics (34.0%) and Asians (28.1%), compared with Whites (19.8%) and Blacks (17.8%), p = 0.0001. Age at time of stroke was highest in Whites (mean 73.1), vs H (65.5), B (63.5), A (66.9); and presenting severity (NIHSS) highest in A (mean 13.5) and H (12.7), vs W (10.7) and B (10.8). A greater dimorphic spread in 3 month outcomes was seen in W than in the other race-ethnic groups: Whites had more excellent (mRS 0-1) 3 month outcomes - W- 42.2%, B- 35.0%, H -28.4%, A-28.0%, p = 0.002; but Whites also had higher mortality by 3m - W-18.2%, A- 15.6%, H-13.0%, B-10.6%, p = 0.007. The race-ethnic difference in mortality was driven by hemorrhagic rather than ischemic strokes: ICH mortality - W-41.7%, A-19.4%, H-19.0%, B-18.2%; IS mortality: A-14.4%, W-13.5%, H-10.5%, B-9.4%. Conclusions: In this multicenter study of acute cerebrovascular disease in a diverse US region, notable race-ethnic differences included higher frequencies of hemorrhagic vs ischemic stroke among Hispanics and Asians; and more excellent, but also more fatal, 3 month outcomes among Whites. These patterns likely distinct different race-ethnic risk factor profiles shaping incident stroke type, as well as divergent sociocultural influences upon robust rehabilitation care and comfort care measures.