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Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables

Published online by Cambridge University Press:  29 June 2017

Neco X. Johnson ,
Maria J. Marquine ,
Ilse Flores ,
Anya Umlauf ,
Carolyn M. Baum ,
Alex W.K. Wong ,
Alexis C. Young ,
Jennifer J. Manly ,
Allen W. Heinemann  and
Susan Magasi
...Show all authors
Neco X. Johnson
Affiliation:
San Diego State University, Department of Psychology, San Diego, California
Maria J. Marquine*
Affiliation:
University of California, San Diego, Department of Psychiatry, San Diego, California
Ilse Flores
Affiliation:
San Diego State University, Department of Psychology, San Diego, California
Anya Umlauf
Affiliation:
University of California, San Diego, Department of Psychiatry, San Diego, California
Carolyn M. Baum
Affiliation:
Washington University in St. Louis, Program in Occupational Therapy, St. Louis, Missouri
Alex W.K. Wong
Affiliation:
Washington University in St. Louis, Program in Occupational Therapy, St. Louis, Missouri
Alexis C. Young
Affiliation:
Washington University in St. Louis, Program in Occupational Therapy, St. Louis, Missouri
Jennifer J. Manly
Affiliation:
Columbia University, Department of Neurology, New York, New York
Allen W. Heinemann
Affiliation:
Northwestern University, Feinberg School of Medicine, Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago, Chicago, Illinois
Susan Magasi
Affiliation:
University of Illinois at Chicago, Department of Occupational Therapy, Chicago, Illinois
Robert K. Heaton
Affiliation:
University of California, San Diego, Department of Psychiatry, San Diego, California
*
Correspondence and reprint requests to: María J. Marquine, Department of Psychiatry, UCSD School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0603. E-mail: mmarquine@ucsd.edu
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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. (JINS, 2017, 23, 640–652)

Keywords

Cerebrovascular accidentInsurance coverageCognitionHealthcare disparitiesHealth literacyAfrican Americans
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 23 , Issue 8 , September 2017 , pp. 640 - 652
Copyright
Copyright © The International Neuropsychological Society 2017 

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