Age Not Key In Explaining Better Post-Stroke Outcomes For Younger Blacks & Latinos

Jan 22, 2020

When it comes to a particular type of stroke, new research suggests younger black or Latino people may experience better outcomes than whites.

A study of patients recovering from hemorrhagic, or bleeding, strokes suggests young black or Latino people may be less likely than young white people to experience disabilities or death within three months of the stroke.

The findings by University of Cincinnati neurologist Daniel Woo, MD, are published in the Jan. 22 online issue of the journal Neurology.

Researchers say the results could shed light on how race may factor into stroke recovery, however more research is needed.

Hemorrhagic strokes occur when a blood vessel in the brain ruptures. They aren't as common and are harder to treat than ischemic strokes, which occur when the flow of blood to the brain is blocked.

This isn't the first time better outcomes have been reported, Woo says. However, it was previously thought  that the better outcomes were related to having the strokes at a younger age. He says this study shows the age at the time of the stroke isn't the key variable.

"Our study found that even when factors that affect outcomes are accounted for, such as how big the stroke is, race and ethnicity were still independent predictors of how well people would recover," Woo says.

The study involved reviewing brain scans of 418 stroke patients from 2010 to 2015 with an average age of 43. Researchers discovered black patients had a 58% lower risk than white white patients and Latino patients had a 66% lower risk. The findings didn't change when adjusted for variables such as age, sex, blood pressure and location and stroke volume.

Perhaps the most stark finding was that blacks and Latinos had half the rate of being disabled following hemorrhagic stroke. "We would have thought it would have been a small change in disability but half is a very big effect size. ... Many treatments that we do improve the rate of disability (by) 5% or 10%; maybe a really big thing reduces disability 20%. But 50%? That's a really large reduction and it suggests a biologic effect."

That's also the next step for researchers. Woo wants to know what's behind the better outcomes and whether it can be replicated. That starts with looking at the differences between patients who were and weren't disabled following the stroke.

That could include some kind of medication the patients may have been taking, genetic differences, or patient response to a stressful event. For example, African Americans and Latinos experience higher levels of stress. Woo wonders if that pre-conditioning could be a reason for the better outcomes.

"There's this paradoxical effect that can happen where populations that live under a great deal of stress - or even patients that have been under suffocation or lack of oxygen to their brain - later on are pre-conditioned; they can handle stroke and heart disease and things like that better than patients who haven't had those kind of experiences. ... If there's a molecular basis for that, maybe we can find something that we could apply to everyone."

He also points out researchers used broad race and ethnicity categories so future studies will need to focus on smaller subgroups.