ArticleStroke2016
Where to Focus Efforts to Reduce the Black-White Disparity in Stroke Mortality: Incidence Versus Case Fatality?
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In one paragraph
Article in Stroke, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 54 papers, 3 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
54citing papers in PubMed, 3 pooled it
4.0field-weighted citation impact, top 7% of its field
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
54 citing papers in PubMed, 3 syntheses or guidelines pooled it, 89 citations in OpenAlex.
- Racial and ethnic disparities in endovascular treatment outcomes in acute ischemic stroke: a systematic review and meta-analysis.Journal of neurology · 2025Pooled it
- Worldwide 1-month case fatality of ischaemic stroke and the temporal trend.Stroke and vascular neurology · 2020Pooled it
- Pooled it
- Trial
- Con-sequins 2026: From mission to momentum.Equity neuroscience · 2026Article
- Secondary stroke evaluation in patients admitted for CRAO in a large national inpatient sample.Stroke and vascular neurology · 2026Article
- Development intensity and incident stroke risk: a longitudinal study of the REGARDS cohort.Cities & health · 2026Article
- Ethnic disparities in the longer-term clinical care and outcomes of stroke patients in England.PloS one · 2026Observational
- A Research Agenda to Mitigate Racial and Ethnic Disparities in U.S. Critical Care Medicine: An Official American Thoracic Society Research Statement.American journal of respiratory and critical care medicine · 2025Article
- Integrating genetic and transcriptomic data to identify genes underlying obesity risk loci.International journal of obesity (2005) · 2025Article
- Everyday discrimination and subclinical indicators of stroke in midlife women.Journal of behavioral medicine · 2025Article
- Stroke Center Certification and Within-Hospital Racial Disparities in Treatment.JAMA network open · 2025Article
- Spirituality and Cardiovascular Health in the HANDLS Study: Evidence for Within-race Differences.Biopsychosocial science and medicine · 2025Article
- Trends in Ethnic Disparities in Stroke Care and Long-Term Outcomes.JAMA network open · 2025Article
- Provision of Stroke Care Services by Community Disadvantage Status in the US, 2009-2022.JAMA network open · 2024Article
- Sherman Lecture: Are We Aiming at the Correct Targets to Reduce Disparities in Stroke Mortality? Celebration, Reflection, and Redirection.Journal of the American Heart Association · 2024Review
- Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving 2023 Update.Journal of the American Heart Association · 2024Article
- Diversity in genetic risk of recurrent stroke: a genome-wide association study meta-analysis.Frontiers in stroke · 2024Article
- Genes, environment, and African ancestry in cardiometabolic disorders.Trends in endocrinology and metabolism: TEM · 2023Review
- The predominant PAR4 variant in individuals of African ancestry worsens murine and human stroke outcomes.The Journal of clinical investigation · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 5 institutions in 1 country.
George HowardFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.). ghoward@uab.edu.
Claudia S MoyFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Virginia J HowardFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Leslie A McClureFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Dawn O KleindorferFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Brett M KisselaFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Suzanne E JuddFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Fredrick W UnverzagtFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Elsayed Z SolimanFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Monika M SaffordFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Mary CushmanFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Matthew L FlahertyFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
Virginia G WadleyFrom the Departments of Biostatistics (G.H., S.E.J.) and Epidemiology (V.J.H.), University of Alabama at Birmingham School of Public Health; Office of Clinical Research, NINDS/NIH, Bethesda, MD (C.S.M.); Department of Epidemiology and Biostatistics, Dornsife School of Public Health at Drexel University, Philadelphia, PA (L.A.M.); Department of Neurology, University of Cincinnati, OH (D.O.K., B.M.K., M.L.F.); Department of Psychology, Indiana University, Indianapolis (F.W.U.); Department of Epidemiology, Wake Forest University School of Medicine, Winston-Salem, NC (E.Z.S.); Department of General Internal Medicine, Weill Cornell School of Medicine, New York, NY (M.M.S., V.G.W.); and Department of Medicine, University of Vermont School of Medicine, Burlington (M.C.).
REGARDS Investigators*
Cornell University · USDrexel University · USIndiana University – Purdue University Indianapolis · USUniversity of Cincinnati · USWake Forest University · US
Funding
VCID and Stroke in a Bi-racial National CohortU01NS041588 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI CUSHMAN, MARY, HOWARD, GEORGE · 2002 to 2022
$96.0MLCenter for Clinical and Translational Science and TrainingUL1TR001425 · NCATS · UNIVERSITY OF CINCINNATI · PI HEUBI, JAMES E., KISSELA, BRETT M · 2015 to 2024
$37.5MUniversity of Alabama at Birmingham's Diabetes Research CenterP30DK079626 · NIDDK · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI Kirk Michael Habegger · 2013 to 2026
$19.5MNCATS NIH HHS UL1 TR001425NIDDK NIH HHS P30 DK079626NINDS NIH HHS U01 NS041588
Abstract
background and purposeAt age 45 years, blacks have a stroke mortality ≈3× greater than their white counterparts, with a declining disparity at older ages. We assess whether this black-white disparity in stroke mortality is attributable to a black-white disparity in stroke incidence versus a disparity in case fatality.
methodsWe first assess if black-white differences in stroke mortality within 29 681 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort reflect national black-white differences in stroke mortality and then assess the degree to which black-white differences in stroke incidence or 30-day case fatality after stroke contribute to the disparities in stroke mortality.
resultsThe pattern of stroke mortality within the study mirrors the national pattern, with the black-to-white hazard ratio of ≈4.0 at age 45 years decreasing to ≈1.0 at age 85 years. The pattern of black-to-white disparities in stroke incidence shows a similar pattern but no evidence of a corresponding disparity in stroke case fatality.
conclusionsThese findings show that the black-white differences in stroke mortality are largely driven by differences in stroke incidence, with case fatality playing at most a minor role. Therefore, to reduce the black-white disparity in stroke mortality, interventions need to focus on prevention of stroke in blacks.
Indexed as
Health Status DisparitiesAgedAged, 80 and overAge FactorsAge of OnsetAnthropometryBlack or African AmericanBlack PeopleComorbidityFemaleFollow-Up StudiesHumansIncidenceMaleMiddle AgedMortalityblackscontinental population groupsincidencemortalitystroke
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