Neurocritical Care

, Volume 17, Issue 3, pp 348–353

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

  • Jeffrey J. Fletcher
  • Lewis B. Morgenstern
  • Lynda D. Lisabeth
  • Brisa N. Sánchez
  • Lesli E. Skolarus
  • Melinda A. Smith
  • Nelda M. Garcia
  • Darin B. Zahuranec
Original Article
  • 167 Downloads

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 

References

  1. 1.
    Degenholtz HB, Thomas SB, Miller MJ. Race and the intensive care unit: disparities and preferences for end-of-life care. Crit Care Med. 2003;31:S373–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Hopp FP, Duffy SA. Racial variations in end-of-life care. J Am Geriatr Soc. 2000;48:658–63.PubMedGoogle Scholar
  3. 3.
    Muni S, Engelberg RA, Treece PD, Dotolo D, Curtis JR. The influence of race/ethnicity and socioeconomic status on end-of-life care in the ICU. Chest. 2011;139:1025–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Romero LJ, Lindeman RD, Koehler KM, Allen A. Influence of ethnicity on advance directives and end-of-life decisions. JAMA. 1997;277:298–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Barnato AE, Berhane Z, Weissfeld LA, Chang CC, Linde-Zwirble WT, Angus DC. Racial variation in end-of-life intensive care use: a race or hospital effect? Health Serv Res. 2006;41:2219–37.PubMedCrossRefGoogle Scholar
  6. 6.
    Caralis PV, Davis B, Wright K, Marcial E. The influence of ethnicity and race on attitudes toward advance directives, life-prolonging treatments, and euthanasia. J Clin Ethics. 1993;4:155–65.PubMedGoogle Scholar
  7. 7.
    Feng W, Nietert PJ, Adams RJ. Influence of age on racial disparities in stroke admission rates, hospital charges, and outcomes in South Carolina. Stroke. 2009;40:3096–101.PubMedCrossRefGoogle Scholar
  8. 8.
    Golestanian E, Liou JI, Smith MA. Long-term survival in older critically ill patients with acute ischemic stroke. Crit Care Med. 2009;37:3107–13.PubMedCrossRefGoogle Scholar
  9. 9.
    Xian Y, Holloway RG, Noyes K, Shah MN, Friedman B. Racial differences in mortality among patients with acute ischemic stroke: an observational study. Ann Intern Med. 2011;154:152–9.PubMedGoogle Scholar
  10. 10.
    United States Census (2010). http://www.census.gov/). Accessed Feb 2012.
  11. 11.
    Eden SV, Meurer WJ, Sanchez BN, et al. Gender and ethnic differences in subarachnoid hemorrhage. Neurology. 2008;71:731–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Morgenstern LB, Smith MA, Lisabeth LD, et al. Excess stroke in Mexican Americans compared with non-hispanic whites: the brain attack surveillance in Corpus Christi Project. Am J Epidemiol. 2004;160:376–83.PubMedCrossRefGoogle Scholar
  13. 13.
    Zahuranec DB, Brown DL, Lisabeth LD, et al. Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. Crit Care Med. 2009;37:2807–11.PubMedCrossRefGoogle Scholar
  14. 14.
    Lisabeth LD, Smith MA, Brown DL, Uchino K, Morgenstern LB. Family history and stroke outcome in a bi-ethnic, population-based stroke surveillance study. BMC Neurol. 2005;5:20.PubMedCrossRefGoogle Scholar
  15. 15.
    Smith MA, Risser JM, Moye LA, et al. Designing multi-ethnic stroke studies: the Brain Attack Surveillance in Corpus Christi (BASIC) project. Ethn Dis. 2004;14:520–6.PubMedGoogle Scholar
  16. 16.
    Williams LS, Yilmaz EY, Lopez-Yunez AM. Retrospective assessment of initial stroke severity with the NIH stroke scale. Stroke. 2000;31:858–62.PubMedCrossRefGoogle Scholar
  17. 17.
    Bejot Y, Aboa-Eboule C, Hervieu M, et al. The deleterious effect of admission hyperglycemia on survival and functional outcome in patients with intracerebral hemorrhage. Stroke. 2012;43:243–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Christensen H, Boysen G. Blood glucose increases early after stroke onset: a study on serial measurements of blood glucose in acute stroke. Eur J Neurol. 2002;9:297–301.PubMedCrossRefGoogle Scholar
  19. 19.
    Weir CJ, Murray GD, Dyker AG, Lees KR. Is hyperglycaemia an independent predictor of poor outcome after acute stroke? Results of a long-term follow up study. BMJ. 1997;314:1303–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Whitcomb BW, Pradhan EK, Pittas AG, Roghmann MC, Perencevich EN. Impact of admission hyperglycemia on hospital mortality in various intensive care unit populations. Crit Care Med. 2005;33:2772–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jeffrey J. Fletcher
    • 1
    • 2
  • Lewis B. Morgenstern
    • 1
    • 2
    • 3
  • Lynda D. Lisabeth
    • 2
    • 3
  • Brisa N. Sánchez
    • 4
  • Lesli E. Skolarus
    • 2
  • Melinda A. Smith
    • 2
  • Nelda M. Garcia
    • 2
  • Darin B. Zahuranec
    • 2
    • 5
  1. 1.Department of NeurosurgeryUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Stroke ProgramUniversity of Michigan Medical SchoolAnn ArborUSA
  3. 3.Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborUSA
  4. 4.Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborUSA
  5. 5.Stroke ProgramUniversity of Michigan Medical SchoolAnn ArborUSA

Personalised recommendations