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J Int Neuropsychol Soc. 2017 Sep;23(8):640-652. doi: 10.1017/S1355617717000480. Epub 2017 Jun 29.

Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables.

Author information

1
1San Diego State University,Department of Psychology,San Diego,California.
2
2University of California,San Diego,Department of Psychiatry,San Diego,California.
3
3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri.
4
4Columbia University,Department of Neurology,New York,New York.
5
5Northwestern University,Feinberg School of Medicine,Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago,Chicago,Illinois.
6
6University of Illinois at Chicago,Department of Occupational Therapy,Chicago,Illinois.

Abstract

OBJECTIVES:

The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke.

METHODS:

One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale.

RESULTS:

An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment.

CONCLUSIONS:

We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).

KEYWORDS:

African Americans; Cerebrovascular accident; Cognition; Health literacy; Healthcare disparities; Insurance coverage

PMID:
28660849
PMCID:
PMC5703208
DOI:
10.1017/S1355617717000480
[Indexed for MEDLINE]
Free PMC Article

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