Abstract
Background:
Among stroke survivors, worse functional outcomes have been reported in race/ethnic minority groups. Race/ethnic differences in post-stroke independent ambulation may be evident early and largely influenced by age. Independent ambulation is defined as the ability to walk without supervision or assistance from another person. Discharge ambulation status may have implications for long term rehabilitation after stroke. We sought to determine the impact of age on race/ethnic differences in discharge ambulation status in the large NINDS-funded FL-PR CReSD Registry of Get With The Guidelines-Stroke (GWTG-S) data.
Methods:
Discharge ambulation status was analyzed for 51,859 acute ischemic stroke (AIS) survivors from 69 FL and 13 PR sites. Multivariate logistic regression models were used to test whether age modifies the relationship between race/ethnicity and independent ambulation at discharge (IAD). Stratified analyses were performed in 3 age groups: 18-64, 65-79, 80+. Models were adjusted for sex, vascular risk factors, independent ambulation status at admission and hospital characteristics.
Results:
IAD was achieved in 52%, of which 71% were non-Hispanic White (NHW), 13% NH Black (NHB), 12% FL Hispanic (FLH), and 4% PR Hispanic (PRH). IAD was most common in NHW (57%), followed by FLH (53%), NHB (47%), and PRH (40%). Older age was associated with lower odds of IAD (18-64: 68%, 65-79: 54%, 80+: 32%). After full adjustment, IAD was less likely in older [65-79 vs 18-64: OR 0.68, 95% CI 0.63-0.73; 80+: OR 0.35, 95% CI 0.32-0.39] and NHB vs. NHW patients [OR 0.85, 95% CI 0.78-0.92]. In age-stratified analyses, NHBs were less likely than NHWs to achieve IAD among those age 65-79 (47% vs. 57%) and 80+ (29% vs 34%) [OR 0.79, 95% CI 0.70-0.90; OR 0.76, 95% CI 0.65-0.88]. This association was not seen in the 18-64 age group (66% vs 69%), [OR 0.97, 95% CI 0.88-1.06].
Conclusions:
About half of AIS survivors are unable to ambulate independently after stroke at discharge. Elderly NHB are less likely to IAD, though the disparity is not observed in working age adults. Post-stroke ambulation is a public health issue that substantially contributes to the economic burden of US healthcare. Further studies are warranted to identify causes of race/ethnic disparities in IAD.