Abstract
Objectives: The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. Methods: One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M = 56.4; SD = 12.6; education: M = 13.7; SD = 2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. Results: An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M = 37.63; SD = 11.67) than Whites (Fluid T-score: M = 42.59, SD = 11.54; p = .006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p = .02, respectively) and significantly mediated racial differences on neurocognitive impairment. Conclusions: We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences.
Original language | English (US) |
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Pages (from-to) | 640-652 |
Number of pages | 13 |
Journal | Journal of the International Neuropsychological Society |
Volume | 23 |
Issue number | 8 |
DOIs | |
State | Published - Sep 1 2017 |
Funding
Conflicts of Interest: The authors report no personal or financial conflicts of interest. Funding: This work was supported by the National Institute on Aging (5R25AG043364-02); the National Institute on Disability and Rehabilitation Research (H133B090024, H133F140037); the National Institute of Mental Health (K23 MH105297); and James S. McDonnell Foundation (JSMF 98.32 CRH-QUA.11).
Keywords
- African Americans
- Cerebrovascular accident
- Cognition
- Health literacy
- Healthcare disparities
- Insurance coverage
ASJC Scopus subject areas
- General Neuroscience
- Clinical Psychology
- Clinical Neurology
- Psychiatry and Mental health