Original Investigation |

Changing Ethnic Disparity in Ischemic Stroke Mortality in US Children After the STOP Trial

Laura L. Lehman, MD1; Heather J. Fullerton, MD, MAS2
[+] Author Affiliations
1Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
2Departments of Neurology and Pediatrics, University of California, San Francisco, San Francisco
JAMA Pediatr. 2013;167(8):754-758. doi:10.1001/jamapediatrics.2013.89.
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Importance  A prior report showed higher stroke mortality in US black children compared with white children (1979-1998), a disparity likely due in part to sickle cell disease, which leads to a high risk of childhood ischemic stroke. We hypothesized that this disparity has diminished since the publication of the Stroke Prevention Trial in Sickle Cell Anemia (STOP trial) in 1998 demonstrating the efficacy of long-term blood transfusions for primary stroke prevention.

Objective  To evaluate the demographics and secular trends in mortality from ischemic and hemorrhagic stroke (as a primary cause of death) in US children (<20 years) and determine if there has been a decrease in the disparity between white and black children since the publication of the STOP trial in 1998.

Design  We used death certificate data from the National Center for Health Statistics, 1988 through 2007.

Setting  United States.

Participants  Children who died in 1988 through 2007 in the United States.

Intervention  Publication of the STOP trial.

Main Outcome Measures  Incidence rate ratios were calculated as the measure of relative risk.

Results  Among 1.6 billion person-years of US children (1988-2007), there were 4425 deaths attributed to stroke, yielding an average of 221 deaths per year; 20% were ischemic; 67%, hemorrhagic; and 12%, unspecified. The relative risk of ischemic stroke mortality for black vs white children dropped from 1.74 from 1988 through 1997 to 1.27 from 1998 through 2007. The ethnic disparity in hemorrhagic stroke mortality, however, remained relatively stable between these 2 periods: black vs white relative risk, 1.90 (1988-1997) and 1.97 (1998-2007).

Conclusions and Relevance  The excess risk of death from ischemic, but not hemorrhagic, stroke in US black children has decreased over the past decade. This may be related to the implementation of an effective ischemic stroke prevention strategy for children with sickle cell disease.

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Figure 1.
Time Trends in US Childhood Stroke Mortality Rates From 1988 Through 2007 in Black Children vs White Children

A, Ischemic stroke. B, Hemorrhagic stroke. A vertical line is drawn to represent when the Stroke Prevention Trial in Sickle Cell Anemia was published.

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Figure 2.
Ischemic Stroke Mortality Rates in US Black Children From 1988 Through 1997 Compared With 1998 Through 2007, Stratified by Age at the Time of Death
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