Biomedical subjects

Byron S Kennedy

Publications and source records attributed to Byron S Kennedy.

3 recordsLinked to original sources

PubMed2005

Does race predict stroke readmission? An analysis using the truncated negative binomial model.

BACKGROUND: Although it is known that the risk of first-ever stroke is higher for blacks than for whites, it is unclear what their relative risk is for stroke recurrence. METHODS: Using statewide inpatient data from California, 4,784 blacks and 33,684 whites having one or more stroke admissions during the year 2000 were identified. For blacks and whites, age- and sex-adjusted incidence rates were calculated for the index stroke admission using direct standardization (to the U.S. resident population for the year 2000). Various statistical models for count data were applied, with the best one being used in subsequent age-specific multivariate analyses for the number of stroke admissions. RESULTS: For the index stroke admission, the age- and sex-adjusted incidence rate per 100,000 was 366 (95% CI 355-377) for blacks and 204 (95% CI 202-207) for whites. Those having two or more stroke admissions accounted for less than 20% of the total number of patients. The truncated negative binomial (TNB) model gave the best fit not only to the California data but also to the data reanalyzed from several prior studies done in various countries [i.e., the United Kingdom (Oxfordshire and South London), Switzerland (Lausanne). Australia (Western Australia) and the United States (Nueces County, TX)]. In this study, predictors of stroke readmission changed according to age. For those aged 65-74 years old, blacks showed a higher risk of readmission than whites by 40% after adjustment for patient and hospital factors (RR 1.40, 95% CI 1.19-1.64). This excess risk was lower in other age groups. CONCLUSIONS: These findings suggest that blacks remain a high-risk group after an initial stroke and warrant appropriate intervention. Future studies on recurrent stroke should consider age-specific TNB models.

Adolescent↗

PubMed2002

Does race predict short-term mortality after carotid surgery? The results of a meta-analysis.

Although African Americans are more likely to have an ischemic stroke and suffer a greater burden of stroke-related mortality and disability, they are less likely to have carotid surgery treatment than whites, even after accounting for clinical characteristics and ability to pay. Not surprisingly, little is known about their short- and long-term outcomes, including death, after undergoing carotid endarterectomy (CEA). The purpose of this study was to systematically review the published literature to clarify what role race has with respect to perioperative mortality risk following CEA. A search of MEDLINE (1966-May 2000), Scientific Citations (1945-May 2000), and the Cochrane Collaboration Stroke Group databases was performed to identify studies that related to African American-white differences for CEA mortality. Three studies met the specified eligibility criteria that allowed for the inclusion of 224,554 subjects (5,569 African Americans and 218,985 whites). Each showed some indication of increasing perioperative mortality risk for African Americans, but the findings were only significant for the studies of Hsia and colleagues (odds ratio (OR), 1.365; 95% confidence interval (CI), 1.164-1.600) and Huber and coworkers(28) (OR, 2.247; 95% Cl, 1.367-3.695) but not for the study of Estes and colleagues (OR, 1.429; 95% Cl, 0.827-2.469). After pooling the data, using a fixed-effects model, the OR was 1.429 (95% CI, 1.235-1.654). There was no evidence of significant heterogeneity between the studies and the random-effects model gave comparable results. African Americans, as compared to whites, appear to have a greater likelihood of short-term death following carotid surgery by more than 40%. This excess risk is possibly related to coexisting illness, which needs to be carefully weighed when considering a patient for CEA. Prospective studies are needed to further clarify these observed differences.

Black or African American↗

PubMedDate not supplied

Trends in hospitalized stroke for blacks and whites in the United States, 1980-1999.

BACKGROUND: Racial differences in stroke mortality are widely recognized, but it is unclear whether or not these differences are due mainly to blacks having a greater stroke incidence or higher case fatality rates compared to those of whites. OBJECTIVES: The aim of this study was to describe the race-specific US trends in hospital discharge rates and in-hospital mortality among stroke patients for the period 1980-1999. It was hypothesized that the hospital discharge rates and in-hospital mortality among stroke patients would be greater for blacks than for whites. METHODS: Data from the National Hospital Discharge Survey for the period 1980-1999 were used to identify stroke subjects according to the codes of the International Classification of Diseases, ninth revision (codes 430-434 and 436). Direct standardization and Poisson regression were used to compare hospitalized stroke morbidity and mortality rates between blacks and whites. The main outcome measures were the number of stroke discharges and in-hospital deaths for black and white stroke patients. RESULTS: Between the years 1980 and 1999, the hospital discharge rates for stroke increased for blacks (n = 8,700) and decreased for whites (n = 46,154); the in-hospital mortality rates decreased for both black and white stroke patients. Generally, the risk of a stroke hospitalization was greater for blacks than for whites by more than 70%, whereas both groups were similar in terms of in-hospital mortality rates among stroke patients. CONCLUSIONS: Differences between blacks and whites in terms of stroke mortality are more likely due to differences in stroke incidence rather than case fatality. These data imply that greater attention should be given to primary/secondary prevention and that additional research is needed to understand the reasons for these patterns.

Adolescent↗