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, doi: 10.1136/bmj.38510.458218.8F, (Published 29 July 2005)

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

Charles D A Wolfe ¹^*, Nigel C Smeeton ¹, Catherine Coshall ¹, Kate Tilling ², Anthony G Rudd ³

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: charles.wolfe{at}kcl.ac.uk.

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

DesignPopulation based stroke register with follow-up.

Settings SouthLondon stroke register.

Participants 2321 patients with firststroke registered between January 1995 and December 2002.

Mainoutcome measures Sociodemographic factors, risk factors forstroke and their management, severity of stroke, and acute serviceprovision factors. Survival analysis with Kaplan-Meier curves,log rank test, and Cox's proportional hazard model with stratification.

ResultsIn univariable analyses of survival, outcome was better forblack 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.

ConclusionIn general, black patients in a south London population withfirst ever stroke are more likely to survive than white patients,the exceptions being in those aged <65 and those with a priorBarthel score <15. Some pre-stroke risk factors that havethe potential to be modified, including the appropriate treatmentof existing health problems, have a strong impact on survival.

(Accepted 27 May 2005)

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Rapid Responses:

Read all Rapid Responses

The findings are amazing indeed!!: Dr Fatai Kunle Salawu,FMCP,MWACP, et al.
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Re: The findings are amazing indeed!!: Charles DA Wolfe
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Ethnicity definition issues: Carole A Cull
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Does the age of onset account for survival differences?: Dougall McCorry
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Re: Ethnicity definition issues: Nigel C Smeeton
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Re: Does the age of onset account for survival differences?: Nigel C Smeeton
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Challenging the hypothesis ethnicity affects survival after stroke.: Dougall Mccorry
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RE: Ethnicity and genetics: John H. Lange
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Re: Challenging the hypothesis ethnicity affects survival after stroke.: Nigel C Smeeton
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Re: Are Black people more likely to survive a stroke than white people?: Nigel C Smeeton
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Challenging the post-stroke median survival times and the impact of stroke unit care on survival: Farzana Parveen Huq
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Prior Barthel <15: C Lim
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