An Investigation of Selection Bias in Estimating Racial Disparity in Stroke Risk FactorsThe REGARDS Study
AbstractSelection due to survival or attrition might bias estimates of racial disparities in health, but few studies quantify the likely magnitude of such bias. In a large national cohort with moderate loss to follow-up, we contrasted racial differences in 2 stroke risk factors, incident hypertension and incident left ventricular hypertrophy, estimated by complete-case analyses, inverse probability of attrition weighting, and the survivor average causal effect. We used data on 12,497 black and 17,660 white participants enrolled in the United States (2003 –2007) and collected incident risk factor data approximately 10 years after baseline. At follow-up, 21.0% of white participants and 23.0% of black participants had died; additionally 22.0% of white participants and 28.4% of black participants had withdrawn. Individual probabilities of completing t he follow-up visit were estimated using baseline demographic and health characteristics. Adjusted risk ratio estimates of racial disparities from complete-case analyses in both incident hypertension (1.11, 95% confidence interval: 1.02, 1.21) and incident left ventricular hypertrophy (1.02, 95% conf idence interval: 0.84, 1.24) were virtually identical to estimates from inverse probability of attrition weighting and survivor average causal effect. Despite racial differences in mortality and attrition, we found little evidence of selection bias in the estimation of racial differences for these i ncident risk factors.
This study sought to evaluate associations between nephrolithiasis and hemorrhagic and ischemic stroke using a national sample cohort from Korea. Data from 2002 to 2013 were collected for individuals ≥ 20 years of age in the Korean National Health Insurance Service (NHIS)-National Sample Cohort. We extracted nephrolithiasis patients (n = 22,636) and 1:4 matched controls (n = 90,544) and analyzed the occurrence of stroke. Matching was performed based on age, sex, income, region of residence, hypertension, diabetes mellitus, and dyslipidemia history. Crude and adjusted hazard ratios (HRs) were calculated using Cox proport...
The study here shows that given a population of individuals with hypertension, those who manage to control their high blood pressure go on to suffer lesser degrees of cognitive decline. Numerous mechanisms may link hypertension to structural damage in the brain: degeneration of the blood-brain barrier, allowing inappropriate molecules and cells into the brain, leading to neuroinflammation and other effects; rupture of capillaries causing microbleeds, effectively tiny strokes; outright pressure damage in tissue very close to small vessels that directly harms brain cells; and so forth. This damage adds up, but note that it i...
CONCLUSION: The entire field of acute stroke care has been revolutionized in the last 60 years. Big data management, telemedicine, software, new brain and vascular imaging techniques, biomarkers, robotics etc., are currently in development and again should lead to new and surprising changes during the next decades. PMID: 31521397 [PubMed - as supplied by publisher]
CONCLUSION: In LCC, the clinical spectrum is largely heterogeneous and the course of the disease appears highly variable in contrast to other hereditary cerebral small vessel diseases. PMID: 31521395 [PubMed - as supplied by publisher]
AbstractBackgroundStroke aetiology, risk factors and outcomes vary among ethnic groups. The profile of patients presenting to hospital with stroke in Ireland is changing as immigration increases. We aim to describe differences that exist between a multi-ethnic immigrant population and native Irish residents.MethodsUsing our hospital's stroke registry we identified all non-Irish (NI) patients admitted to the stroke unit over a two year period through surname recognition (N=44). Country of birth was confirmed by a chart review. The Irish patients admitted over the same time frame were used as a comparis...
ConclusionThis audit shows that roughly one third of patients do not bring up-to-date lists of medications to their outpatient appointments and only a small proportion of patients feel that they themselves have the most up-to-date list of their own medications. Suggested areas for improvement include patient education campaigns, reminder letters/text messages to patients prior to their clinic appointments and the introduction of a Clinical Pharmacist to the outpatient setting.
ConclusionThe average length of stay was 16.1 days, considerably higher than the national stroke unit average of 9. The overall mortality rate was 5% higher than the national of 13%. Limited rehabilitation services and time awaiting national rehabilitation beds contributed to the long LOS. There is a definite need for a dedicated stroke service at our hospital, local analysis suggests that 6 beds would meet the needs of our catchment area; and this would lead to better outcomes for stroke patients. A further locally dedicated stroke audit is needed.
ConclusionThe prognostic value of Fibrinogen after stroke or TIA remains unclear. Standardised methods and fully-adjusted multivariable analysis are needed in future prognostic studies.
ConclusionThese results illustrate areas in which we can improve education post-stroke, including ensuring patients receive individualised information about the aetiology of their stroke, risk factors and the importance of new medications. It also highlights the importance of ensuring advice regarding driving is clearly explained and documented.
ConclusionIn this pilot study, through the use of early ABPM we found high rates of non-dipping nocturnal BP in patients following stroke, particularly in those with underlying atrial fibrillation. The availability of 24-hour BP might allow for more individualised antihypertensive management particularly at this high-risk acute stage. Furthermore the presence of abnormal circadian patterns might be a marker for conditions such as atrial fibrillation and obstructive sleep apnoea that compound stroke risk.