Mexican-Americans suffer worse outcomes after stroke

Mexican-Americans have increased stroke risk, but lower risk of death compared to non-Hispanic whites. The new research suggests that prolonged survival is at the expense of increased disability.

The study's stroke participants were drawn from the Brain Attack Surveillance in Corpus Christi (BASIC) project conducted in a non-immigrant south Texas community. Researchers assessed neurologic outcome for 513 people; functional outcome for 510 people; and 415 for cognition (64 percent were Mexican-American).

Mexican-American stroke survivors were younger with a median age of 65, compared to a median 72 years for non-Hispanic whites. Women represented about half of those in the study.

Researchers found:

• Mexican-Americans had moderate functional disability and nearly one-third had post-stroke dementia.
• Mexican-Americans had a 48 percent worse neurologic outcome score compared to non-Hispanic whites on the National Institutes of Health Stroke Scale. They also scored worse on language dysfunction and several other items from this scale.
• Mexican-Americans had worse cognitive outcome on the Modified Mini-Mental State Examination.

"What we found most notable was the difference in functional outcome," said Lynda Lisabeth, Ph.D., M.P.H., study lead author and interim chair and associate professor of epidemiology at the University of Michigan School of Public Health in Ann Arbor, Mich. "Mexican-Americans did worse on all the measures of daily living activities compared to non-Hispanic whites."

Researchers analyzed functional outcome by the activities of daily living score (ADL) and the instrumental activities of daily living score (IADL). The ADL score measures seven functional activities: walking, bathing, grooming, eating, dressing, moving and toileting. The IADL score includes 15 questions related to daily functioning.

The level of functional impairment among Mexican-Americans was substantial. This is important given increasing functional impairment is highly predictive of nursing home admission and the need for informal care, researchers said.

"This study provides the first piece of information on the prognosis of Mexican-American stroke survivors," Lisabeth said. "The clinical and public health information we discovered is important for future research in stroke prevention and rehabilitation in stroke survivors. We don't yet have a complete picture of recovery for Mexican-Americans and what potential intervention strategies can improve their recovery."