Race/Ethnicity and location of stroke mortality - Implications for population-based studies

Background and Purpose-Stroke community surveillance projects often focus o n hospital data rates. We hypothesized that not including strokes which occ urred in nursing homes or at home would differentially affect race/ethnic s troke rates. Methods-Texas vital statistics data were studied to compare age-specific (4 5 to 59, 60 to 74, and greater than or equal to 75 years) location of strok e death for African Americans (AAs), Hispanic Americans (HAs), and non-Hisp anic whites (NHWs). Rate ratios are reported with 95% CIs; NHW is used as t he referent group. Results-During 1991 to 1996, there were 52 996 stroke deaths in Texas for i ndividuals aged 45 years and older. HAs in the oldest age group (greater th an or equal to 75 years) were 33% more likely than NHWs to die in the hospi tal, and HAs aged 45 to 59 and 60 to 74 years were 4% and 10%, respectively , more likely to die in the hospital. AAs aged greater than or equal to 75 years were 19% more likely to die in the hospital. HAs aged 60 to 74 years were 35% less likely to die in a nursing home, whereas HAs aged greater tha n or equal to 75 years were 43% less likely than NHWs to die in a nursing h ome. AAs aged greater than or equal to 75 were 33% less likely to die in a nursing home. Death at home was 19% more likely in HAs aged 60 to 74 years. Significant gender differences are also reported. Conclusions-Using hospital data alone would overestimate stroke mortality i n the HA and AA groups. Stroke community surveillance projects should accou nt for ethnic and gender differences in location of death to avoid bias in race/ethnic and gender comparisons.