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

doi:10.1136/bmj.38510.458218.8F

BMJ 2005;331:431 (20 August), doi:10.1136/bmj.38510.458218.8F (published 29 July 2005)

Paper

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

Charles D A Wolfe, professor of public health medicine¹, Nigel C Smeeton, lecturer in medical statistics¹, Catherine Coshall, research associate¹, Kate Tilling, senior lecturer in medical statistics², Anthony G Rudd, consultant stroke physician³

¹ Division of Health and Social Care, King's College London, London SE1 3QD, ² Department of Social Medicine, Clifton, Bristol BS8 2PR, ³ Department of Ageing and Health, St Thomas' Hospital, London SE1 7EH

Correspondence to: C D A Wolfe charles.wolfe{at}kcl.ac.uk

Objectives To identify ethnic differences in survival afterstroke and examine the factors that influence survival.

Design Population based stroke register with follow-up.

Settings South London stroke register.

Participants 2321 patients with first stroke registered betweenJanuary 1995 and December 2002.

Main outcome measures Sociodemographic factors, risk factorsfor stroke and their management, severity of stroke, and acuteservice provision factors. Survival analysis with Kaplan-Meiercurves, log rank test, and Cox's proportional hazard model withstratification.

Results In univariable analyses of survival, outcome was betterfor 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, takinginto account the interaction between ethnicity and age, andethnicity and prior Barthel score. Of the risk factors for strokeconsidered, current smoking (hazard ratio 1.21, 95% confidenceinterval 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, 1.05to 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 populationwith first ever stroke are more likely to survive than whitepatients, the exceptions being in those aged < 65 and thosewith a prior Barthel score < 15. Some pre-stroke risk factorsthat have the potential to be modified, including the appropriatetreatment of existing health problems, have a strong impacton survival.

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Rapid Responses:

Read all Rapid Responses

The findings are amazing indeed!!: Dr Fatai Kunle Salawu,FMCP,MWACP, et al.
bmj.com, 30 Jul 2005 [Full text]
Re: The findings are amazing indeed!!: Charles DA Wolfe
bmj.com, 1 Aug 2005 [Full text]
Ethnicity definition issues: Carole A Cull
bmj.com, 19 Aug 2005 [Full text]
Does the age of onset account for survival differences?: Dougall McCorry
bmj.com, 19 Aug 2005 [Full text]
Re: Ethnicity definition issues: Nigel C Smeeton
bmj.com, 22 Aug 2005 [Full text]
Re: Does the age of onset account for survival differences?: Nigel C Smeeton
bmj.com, 22 Aug 2005 [Full text]
Challenging the hypothesis ethnicity affects survival after stroke.: Dougall Mccorry
bmj.com, 24 Aug 2005 [Full text]
RE: Ethnicity and genetics: John H. Lange
bmj.com, 28 Aug 2005 [Full text]
Re: Challenging the hypothesis ethnicity affects survival after stroke.: Nigel C Smeeton
bmj.com, 30 Aug 2005 [Full text]
Survival of patients with stroke and Growth-Factors: Salvador Vale
bmj.com, 6 Sep 2005 [Full text]
Are Black people more likely to survive a stroke than white people?: Farzana Parveen Huq
bmj.com, 1 Jul 2006 [Full text]
Re: Are Black people more likely to survive a stroke than white people?: Nigel C Smeeton
bmj.com, 4 Jul 2006 [Full text]
Challenging the post-stroke median survival times and the impact of stroke unit care on survival: Farzana Parveen Huq
bmj.com, 9 Mar 2007 [Full text]
Prior Barthel <15: C Lim
bmj.com, 31 Mar 2009 [Full text]
Re: Prior Barthel <15: Nigel C Smeeton
bmj.com, 1 Apr 2009 [Full text]