Racial differences in disability after stroke: Results from a nationwide study

Objective: We sought to characterize racial differences in disability among older stroke survivors. Methods: A cross-sectional study of 806 self-reported stroke survivors from the 2011 National Health and Aging Trends Study was performed. Race was based on self-report. Primary outcome was activity limitations (requiring assistance with mobility, self-care, and household activities). Secondary outcome was participation restrictions, which were defined as reductions/absence in valued social activities because of health. Physical capacity was measured by a validated scale (0 low-12 high). Logistic regression was used to estimate average marginal effects of activity limitations and participation restrictions by race before and after adjusting for sociodemographics, comorbidities, and physical and cognitive capacity. Results: Non-Hispanic black participants had lower physical capacity than non-Hispanic white participants (mean 5.1 vs 6.9, p < 0.01). For most activities, black participants had significantly greater limitations than white participants. These differences persisted after accounting for sociodemographic factors and comorbidities, but largely became nonsignificant after accounting for physical capacity. The only unadjusted racial difference in participation restriction was in religious service attendance (18.2% of white participants vs 28.6% of black participants, p < 0.01). Conclusion: After stroke, black individuals have a greater prevalence of activity limitations than white individuals, largely due to their greater physical capacity limitations. Further understanding of the causes of racial differences in capacity after stroke is needed to reduce activity limitations after stroke and decrease racial disparities.