Elevated Stroke Morbidity and Mortality in Asian Americans: an Exploratory Analysis
Catherine Imossi1, Benjamin Jadow1, Christopher Chornay1, Sungita Kumar1, Esther Kim2, Jose Torres1, Koto Ishida1, Brandon Giglio1, Rajanandini Muralidharan3, Ariane Lewis1, Myrna Cardiel1, Jeana Gratch1, Steven Galetta1, Kara Melmed1
1NYU Langone Medical Center, 2New York University, 3Winthrop Neuroscience
Objective:
To explore drivers underlying morbidity and mortality among Asian patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH).
Background:
Existing literature presents conflicting evidence on stroke-related morbidity and mortality among Asian American patients.
Design/Methods:
Retrospective study of AIS and ICH patients aged ≥18 years and discharged from the neurology department at three comprehensive stroke centers from Jan 1 2023- Dec 31 2024. Demographic factors, social determinants of health including pre-hospital health care utilization, clinical admission factors, and discharge data were abstracted from the chart. Chi-squared and one-way ANOVA analyses were performed.
Results:
We identified 9352 patients with acute stroke (mean age 56.9±22.5 years and 49% female, 10% Asian). Median household income by zip code was higher for Asian patients ($104,236 [IQR=63,564]) than non-Asian patients ($73,927 [IQR=55,845]). Initial NIHSS was higher in Asian patients (7.9±8.8) compared to non-Asian patients (5.6±7.3) (p<.001). Asian patients had a higher rate of in-hospital mortality (4.9% vs. 3%, p=0.009) as well as higher discharge mRS (2.6±1.9 vs. 2.4±1.8, p=.05). Among Asian patients, discharge mRS was higher in non-English proficient patients (2.9±1.8) compared to English-proficient patients (2.0±1.8) (p<.001). Among two largest Asian subgroups, Chinese (n=431) and Indian (n=71), Chinese patients were more likely to have ICH (p<.001) and had a higher discharge mRS (2.9±1.8) than Indian patients (2.0±1.9) (p<.001). Chinese and Indian patients had similar rates of primary care doctor visits (p =.251) and smoking (p =.535).
Conclusions:
Our data show that Asian patients had higher initial NIHSS scores, worse discharge mRS, and greater in-hospital mortality, despite residing in higher-income zip codes. Chinese patients, in particular, had worse overall outcomes evidenced by higher rates of mortality, ICH, and elevated discharge mRS compared to other Asian subgroups. This occurred despite similar rates of smoking and primary care engagement.
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