Stroke is the fifth leading cause of death in the US and can result in major disability. Depression can increase risk of stroke and death from stroke, and it is related to worse post-stroke outcomes. There is a dearth of research in Hispanic people, who have a higher burden of disease than non-Hispanic people. The goal of this project was to determine how ethnicity and prior depression affect patient outcomes after first-time stroke.
Five hundred cases from Baptist Hospital's Get With The Guidelines-Stroke database (9/14-5/15) were analyzed. It was a 2 (Hispanic, non-Hispanic) x 2 (prior depression, no prior depression) factorial cross-sectional design. Descriptive statistics analyzed subjects on baseline characteristics (demographics, comorbidities, and NIH Stroke Scale score), hospital course [IV t-PA or neuro-intervention and their turnaround times, and length of stay (LOS)], discharge functional status [modified Rankin Scale (mRS)], and discharge disposition. Nonparametric median test was used for LOS and χ2 analysis was used for mRS and disposition.
Of 500 cases, 199 were excluded because of: prior stroke, TIA, MI, or atrial fibrillation, or LOS≥30 days. Of 301 cases, 195 patients were Hispanic (65%), and 30 had depression (21/195 Hispanic, 12%; 9/97 non-Hispanic, 9%). A marginally significant interaction of ethnicity and depression was found (p=0.061), such that non-Hispanic patients with depression had a shorter LOS than the other groups (3.7 d vs. 6.3-6.9 d). Of 301 patients, 171 (57%) were discharged home. Hispanic patients were less likely to be discharged home (54%) vs. 62% of non-Hispanic patients, regardless of depression. Of 279 patients with a mRS score, 98 (35%) had a good clinical outcome. Only 1/4 of Hispanic patients with depression had a good clinical outcome, vs. 1/3 of patients in the other groups.
There was an interaction of ethnicity and depression on LOS where non-Hispanic patients with depression had a shorter LOS than other groups. These findings may be clinically important. It is critical to determine whether these patients had less severe strokes or fewer comorbidities, or if patients were discharged too quickly.
11th Annual BHSF Research Conference
Baptist Health South Florida Affiliations:
Amy Starosciak, PhD
Starosciak, Amy, "Effects of Ethnicity and Prior Depression on Hospital Course and Outcomes in First-Time Stroke Patients" (2016). All Publications. 2674.
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