A study published online in JAMA Neurology on January 22 that compared stroke outcomes in Asian-Americans with whites found that Asian Americans are more likely to have more severe strokes and experience worse recovery and complications.

Previous Research Shows Higher Rates of Stroke Among Asian Americans

Previous research shows that Asian Americans have a higher rate of disease and mortality from stroke. More specific studies show that Asian Americans and Pacific Islanders die from primary intracerebral hemorrhage—a stroke caused by a ruptured blood vessel bleeding inside the brain—at a higher rate than whites.

In the United States, the frequency of stroke and death from stroke is declining, but because Asian Americans have historically been understudied, data on characteristics and clinical outcomes of stroke have been limited.

Comparing Asian Americans with Whites

To compare clinical care and in-hospital outcomes for stroke among Asian Americans and whites, a team of researchers analyzed data from 64,337 Asian American patients and 1,707,962 white patients admitted for acute ischemic stroke to hospitals participating in the American Heart Association/ American Stroke Association’s Get With The Guidelines–Stroke (GWTG-Stroke) program, a voluntary in-hospital program for improving stroke care by following the latest scientific treatment guidelines, from 2004 to 2016.

The Asian American group included people of mixed heritage, such as Asian Indian, Chinese, Filipino, Korean, Japanese, and Vietnamese.

The team assessed stroke incidence using the National Institutes of Health Stroke Scale (NIHSS), which measures severity of stroke; use of intravenous tissue plasminogen activator (IV tPA), a drug that busts clots; and post-tPA complications, such as intracerebral hemorrhage. IV tPA is the only treatment for ischemic stroke approved by the U.S. Food and Drug Administration.

The researchers assessed whether patients died in the hospital, how long they stayed, when they were discharged, whether they could walk at discharge, and level of disability or dependence after the stroke.

Asian Americans Had More Severe Strokes

Asian Americans were more likely to experience severe strokes and more disability and dependence after a stroke compared to whites. They were also less likely to receive IV tPA. When they did receive tPA, they were more likely to experience intracerebral hemorrhage within 36 hours of receiving it and other post-tPA complications.

Asian Americans also were in the hospital longer. When they were discharged, they were more likely to have trouble walking and be disabled. This group also had higher mortality rates in the hospital, a trend that improved after the researchers corrected for stroke severity.

Between 2004 and 2016, the incidence of stroke decreased in both groups, but whites had fewer severe strokes in that 8-year time period while Asian Americans experienced no change in stroke severity.

Study Limitations

Overall, Asian Americans experience more severe strokes and more complications, and are less likely to receive tPA, the researchers concluded.

The study was limited, however, by a database that consisted of voluntary participating hospitals, where the quality of stroke care may be higher than in nonparticipating hospitals, and by combining all Asian Americans into one group, which limits information for subgroups.

"Further research is necessary to better define interventions that can improve the disparities that Asian American patients experience in acute ischemic stroke," the researchers wrote.