Despite significant advances in prevention and acute treatment of cerebrovascular disease in the last few decades, stroke remains the leading cause of adult disability in the United States. Health care costs related to stroke total over $65 billion per year in the US alone. Disproportionate morbidity and mortality from stroke falls on underserved populations. The incidence of stroke, as well as mortality from stroke, is significantly higher in blacks compared to whites. In the Northern Manhattan Stroke Study (NOMASS), Sacco and colleagues found a 2.4 fold increase in stroke incidence in blacks and a twofold increase in Hispanics compared to whites. Bian and colleagues found that, compared to white patients, black patients were 6% more likely to die after an ischemic stroke. Subgroup analyses further suggested that black patients aged 65 to 74 had much lower 3-year survival probabilities (15 to 20%) than their white counterparts. An analysis of racial/ethnic differences in stroke mortality in Texas for the 5-year period between 1988-1992 demonstrated that blacks had a 3-4 fold increased stroke mortality relative to non-Hispanic whites at young ages. Moreover, studies have shown that blacks have a 2 fold increased risk for intracerebral hemorrhages compared to whites, and mortality from this condition in blacks seems to be highest at younger ages (45-59 years of age). In addition to these numerous studies demonstrating increased incidence and mortality from stroke, studies have also suggested that blacks experience more severe strokes than whites. Outcomes in these population-based studies have focused on mortality or stroke recurrence, data readily available from existing databases.
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