TRIP

Survival differences after stroke in a multiethnic population: follow-up study with the South London stroke register.

BMJ, 2005

Comment in: Survival differences after stroke in a multiethnic population: follow-up study with the South London stroke register.
charles.wolfe@kcl.ac.uk OBJECTIVES: To identify ethnic differences in survival after stroke and examine the factors that influence survival.
MAIN OUTCOME MEASURES: Sociodemographic factors, risk factors for stroke and their management, severity of stroke, and acute service provision factors.
Survival analysis with Kaplan-Meier curves, log rank test, and Cox's proportional hazard model with stratification.
RESULTS: In univariable analyses of survival, outcome was better for black people than white people (median 33.7 v 20.0 months).
After stratification by socioeconomic status, type of stroke, and Glasgow coma score, and adjustment for other potential confounders, being black was generally associated with better survival, taking into account the interaction between ethnicity and age, and ethnicity and prior Barthel score.
Of the risk factors for stroke considered, current smoking (hazard ratio 1.21, 95% confidence interval 1.01 to 1.45, P = 0.044), untreated atrial fibrillation (1.36, 1.08 to 1.72, P = 0.009), untreated diabetes (1.53, 1.05 to 2.22, P = 0.027), and treated diabetes (1.61, 1.27 to 2.03, P < 0.001) were associated with reduced survival.
CONCLUSION: In general, black patients in a south London population with first ever stroke are more likely to survive than white patients, the exceptions being in those aged < 65 and those with a prior Barthel score < 15.
Some pre-stroke risk factors that have the potential to be modified, including the appropriate treatment of existing health problems, have a strong impact on survival.