Racial And Ethnic Disparities In Stroke. Declining Age At Time Of Stroke. Analysis Of The Nationwide Inpatient Sample 1988-2010 (S12.002)

OBJECTIVE: To determine if age at time of stroke was declining throughout the US BACKGROUND: Kisella et. al. recently reported that the age at time of stroke was declining in the biracial population of the Greater Cincinnati/Northern Kentucky region. (Neurology 2012;79:1781-1787). DESIGN/METHODS: Retrospective cohort analysis of the Nationwide inpatient sample from 1988-2010, a stratified sample of 20% of U.S. hospitalizations. Admissions with a primary diagnosis of stroke (ischemic or hemorrhagic) were identified. Cohorts were defined by race and ethnicity and by year. Four groupings of years were used 1988-92, 1993-8, 1999-2004, 2005-2010. Analysis of covariance (ANCOVA, proc GLM, SAS v 9.3) was used for the primary outcome, with p set a prior at 0.001. Possible explanatory variables included gender, socio-economic status as reflected by their insurance status and comorbidities using the Charlson-Deyo index (J ClinEpidemiol 1992;45:613-9). RESULTS: Of the 2.6 million admissions, race or ethnicity was suppressed in 28.2%. Leaving 1,923,101 million stroke admissions for comparison. Overall the age was older for white compared to blacks, Hispanics, Asian/Pacific Islanders, Native Americans. Over the 24 years of this study age declined for blacks (mean age from 67 to 65 ) and Hispanics, (70 to 68 ; p <0.0001). Insurance status co-varied with age and the Charlson-Deyo index. Younger people with more comorbidities tended to have Medicaid or Medicare, while older people with fewer comorbidities tended to have private insurance or Medicare. CONCLUSIONS: In this longitudinal national sample age at time of stroke became younger for blacks and Hispanics, but not Caucasians. This has increased the disparity of age of onset between blacks and Caucasians. Over time the number of comorbidities have increased, perhaps due to upcoding by hospitals rather than worsening health status of the population. Disclosure: Dr. Costa has nothing to disclose. Dr. Dubinsky has received personal compensation for activities with Allergan Inc. Dr. Dubinsky has received research support from Allergan Inc., Medevation Pharmaceuticals, and from the National Institutes of Health.