Original Article

Neurocritical Care

, Volume 17, Issue 3, pp 348-353

First online:

A Population-Based Analysis of Ethnic Differences in Admission to the Intensive Care Unit after Stroke

  • Jeffrey J. FletcherAffiliated withDepartment of Neurosurgery, University of Michigan Medical SchoolStroke Program, University of Michigan Medical School
  • , Lewis B. MorgensternAffiliated withDepartment of Neurosurgery, University of Michigan Medical SchoolStroke Program, University of Michigan Medical SchoolDepartment of Epidemiology, University of Michigan School of Public Health
  • , Lynda D. LisabethAffiliated withStroke Program, University of Michigan Medical SchoolDepartment of Epidemiology, University of Michigan School of Public Health
  • , Brisa N. SánchezAffiliated withDepartment of Biostatistics, University of Michigan School of Public Health
  • , Lesli E. SkolarusAffiliated withStroke Program, University of Michigan Medical School
  • , Melinda A. SmithAffiliated withStroke Program, University of Michigan Medical School
  • , Nelda M. GarciaAffiliated withStroke Program, University of Michigan Medical School
  • , Darin B. ZahuranecAffiliated withStroke Program, University of Michigan Medical SchoolStroke Program, University of Michigan Medical School Email author 

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Abstract

Background

Mexican–Americans (MAs) have shown lower post-stroke mortality compared to non-hispanic whites (NHWs). Limited evidence suggests race/ethnic differences exist in intensive care unit (ICU) admissions following stroke. Our objective was to investigate the association of ethnicity with admission to the ICU following stroke.

Methods

Cases of intracerebral hemorrhage and acute ischemic stroke were prospectively ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project for the period of January 2000 through December 2009. Logistic regression models fitted within the generalized additive model framework were used to test associations between ethnicity and ICU admission and potential confounders. An interaction term between age and ethnicity was investigated in the final model.

Results

A total 1,464 cases were included in analysis. MAs were younger, more likely to have diabetes, and less likely to have atrial fibrillation, health insurance, or high school diploma than NHWs. On unadjusted analysis, there was a trend toward MAs being more likely to be admitted to ICU than NHWs (34.6 vs 30.3 %; OR = 1.22; 95 % CI 0.98–1.52; p = 0.08). However, on adjusted analysis, no overall association between MA ethnicity and ICU admission (OR = 1.13; 95 % CI 0.85–1.50) was found. When an interaction term for age and ethnicity was added to this model, there was only borderline evidence for effect modification by age of the ethnicity/ICU relationship (p = 0.16).

Conclusions

No overall association between ethnicity and ICU admission was observed in this community. ICU utilization alone does not likely explain ethnic differences in survival following stroke between MAs and NHWs.

Keywords

Intracerebral hemorrhage Acute ischemic stroke Mexican Americans Intensive care unit