Abstract Body: Introduction: Studies have reported racial disparities in acute stroke treatment and follow-up care in young patients which lead to less desirable outcomes for minorities. This study aimed to identify potentially modifiable factors for better stroke treatment and prevention in minority populations.
Methods: Young patients aged 18-50 years who were admitted with ischemic stroke during 09/2016-12/2022 were retrospectively identified and stratified as non-Hispanic White (WH), non-Hispanic Black (BL), and Hispanic (HS). Racial differences in risk factors, stroke etiology, acute intervention, and follow-ups were examined using Chi-square and Kruskal-Wallis tests as appropriate. Cumulative probabilities of stroke recurrence were estimated using the Kaplan-Meier (KM) method and tested with the Log-rank (Mantel-Cox) test. A logistic regression was used to evaluate the odds ratio of favorable functional outcomes (mRS ≤2) by 90 days. A backward stepwise Cox regression was conducted to identify predictors of stroke recurrence reported as hazard ratio (HR) and a 95% confidence interval (CI).
Results: A total of 318 patients were identified with a median age of 43 and 57.5% male, covering 57.2% WH, 22.3% BL, and 20.4% HS. Compared to WH, more BL and HS were comorbid with diabetes, hypertension, and prior stroke (p<0.05). The rates of other risk factors did not vary by race. The distribution of stroke etiologies and rate of acute interventions (IV tPA, thrombectomy) were similar among the three. After discharge, 77.3% of young patients had ≥1 follow-ups at stroke clinic. The total number of stroke clinic follow-ups were similar among racial groups. At 90 days, 89.6% of patients achieved mRS≤2; the odds of having this favorable functional outcome were similar among racial groups (p=0.207). The KM curve indicates that the first-year risks of stroke recurrence were similar among racial groups and that a trend showed BL had the highest risk of recurrent strokes, followed by HS, and WH had the lowest risk in 1-3 year follow up. Yet, these differences were not statistically significant (p=0.056. BL was found to have 2.7 times higher risk to have a recurrent stroke than whites (HR: 3.7; 95% CI: 1.4-10.1; p=0.01).
Conclusions:
Findings highlighted high prevalence of hypertension and diabetes in young BL and HS and a higher risk of recurrent stroke in young BL, suggesting tailored interventions for comorbidities are urged for better stroke prevention in minorities.