Racial Disparities in the Development of Dysphagia After Stroke: Further Evidence From the Medicare Database

Objective: To describe the relationship between minority race/ethnicity and dysphagia after stroke in a national sample. Unlike the multiple studies that have examined racial disparities in stroke incidence, risk factors, outcomes, and quality of care, the influence of race or ethnicity on dysphagia after stroke has been understudied. We hypothesized that the odds of dysphagia would be higher for Asians compared with Caucasians in the United States given the results of a previous study in the U.S. Design: Observational study. Setting: Conducted using the U.S. National Medicare Medical Provider Analysis and Review Data. Participants: Medicare beneficiaries admitted in 2007 with a stroke diagnosis. Intervention: We selected 382,959 cases with cerebrovascular disease codes with self-identified race/ethnicity of Caucasian, African American, Asian, Hispanic, Native American, or other/unknown. Cases had a diagnosis of cerebrovascular disease, defined as International Classification of Disease, Ninth Revision codes 430 to 438.9. Self-reported race/ethnicity was recorded in the following categories: Caucasian, African American, Asian, Hispanic, Native American, and other/unknown. Main Outcome Measure: Dysphagia after stroke as coded in the data. Results: The adjusted odds ratio (OR) for poststroke dysphagia was higher for Asians and other minority groups compared with Caucasians (Asian: OR, 1.73; 95% confidence interval [CI], 1.60-1.88; Hispanic: OR, 1.50; 95% Cl, 1.39 1.63; African American: OR, 1.42; 95% Cl, 1.37-1.47; unknown/other: OR, 1.27; 95% Cl, 1.16-1.38; Native American; OR, 1.44; 95% Cl, 1.22-1.69). Conclusions: Our findings confirm previous research suggesting an association between Asian race and dysphagia after stroke while adding evidence for increased odds in other racial/ethnic minority groups.