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From the Stroke Center, Department of Neurology (Drs. Hartmann, Rundek, Mast, Mohr, and Sacco, and B. Boden–Albala), Sergievsky Center (Dr. Sacco), and Divisions of Epidemiology (Dr. Sacco), Socio-Medical Science (B. Boden-Abala), and Biostatistics (Dr. Paik), Columbia University College of Physicians and Surgeons and School of Public Health, New York, NY; Stroke Unit (Dr. Hartmann), Universitätsklinikum Benjamin Franklin, Freie Universität Berlin; and Stroke Unit (Dr. Mast), Berufsgenossenschaftliche Kliniken, Bergmannstrost, Halle, Germany.
Address correspondence and reprint requests to Dr. Andreas Hartmann, Stroke Unit, Department of Neurology, Klinikum Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany; e-mail: ahart{at}zedat.fu-berlin.de
Objective:— To analyze the early and long-term causes of death after first ischemic stroke in the multiethnic northern Manhattan community.
Methods:— In the prospective, population-based Northern Manhattan Stroke Study, 980 patients with first ischemic stroke (mean age 70 years; 56% women; 49% Caribbean Hispanic, 31% black, 20% white) were followed for a mean of 3 years. Causes of death were classified as vascular (incident stroke, recurrent stroke, cardiac) or nonvascular. Life table analyses were used to assess mortality risks among different race-ethnic groups. Early (
1 month) vs long-term (>1 month to 5 years) causes of death were compared.
Results:— Among the 980 patients followed, 278 (28%) died; 47 (5%) died during the first month. Cumulative mortality risk was 5% at 1 month, 16% after 1 year, 29% after 3 years, and 41% after 5 years. The proportion of vascular deaths among all deaths was 75% at 1 month and 43% thereafter (p = 0.001). Stroke, either incident (53%) or recurrent (4%), caused early deaths in 57% and long-term deaths in 14% (p = 0.001). Overall mortality risks did not differ significantly among race-ethnic groups. However, the proportion of incident stroke-related early deaths was 85% in Caribbean Hispanic patients, 33% in white patients, and 25% in black patients (p = 0.002).
Conclusions:— Among patients with first ischemic stroke, incident stroke is the leading cause of early deaths. A large proportion of long-term deaths are nonvascular in origin. Despite similar overall mortality rates in race-ethnic groups, our data suggest a higher incident stroke-related early mortality among Caribbean Hispanics.
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