One-year disability, death and recurrence after first-ever stroke in a Black Afro-Caribbean population

Abstract

Background Few data on stroke outcomes and no data on stroke recurrence are available in Black mono-racial population with high socio-economic status. Aims We investigated outcomes and stroke recurrence at one year in the Black Afro-Caribbean population of Martinique and examined potential predictors of poor prognosis and recurrence. Methods Patients from ERMANCIA II (Etude Réalisée en MArtinique et Centrée sur l’Incidence des Accidents vasculaires cérébraux), a Black population-based and prospective observational study, were followed up at 28-days, three months and one year post stroke. Stroke characteristics, survival, disability (modified Rankin Scale > 2), and stroke recurrence were assessed. A survival-based approach was used for time-to-event analysis, and multivariable regression analysis assessed the predictors of death, disability and stroke recurrence. Results Of 544 first-ever stroke patients, cumulative risks of death increased from 17.6% (95% confidence interval, 14.5–20.4) at 28 days to 22.8% (18.6–25.0) at three months and to 31.3% (27.4–34.6) at one year. Disability rates in survivors decreased from 43.7% (39.5–47.2) at 28 days to 35% (30.9–38.4) at three months and to 28.8% (24.9–32.1) at one year. Cumulative risks of recurrent stroke were estimated to 2.1% (0.9–2.9) at 28 days, 4.5% (2.7–6.1) at three months and 9.3% (6.1–11.6) at one year. Age (odds ratio (OR), 1.08 (1.05–1.10)), admission NIHSS (OR, 1.22 (1.17–1.29)), metabolic syndrome (OR, 2.07 (1.22–3.52)) and recurrence (OR, 5.06 (1.87–13.7)) were independent predictors of death or disability at one year. Conclusion Stroke Outcomes in Black Afro-Caribbean population with a high socio-economic status appear globally similar to outcomes reported in Caucasian population. After a first-ever stroke, the implementation of early programs of recurrence prevention seems crucial to reduce the risk of poor prognosis at one year.