Stroke Quality Measures in Mexican Americans and Non-Hispanic Whites

Mexican Americans (MAs) have been shown to have worse outcomes after stroke than non-Hispanic Whites (NHWs), but it is unknown if ethnic differences in stroke quality of care may contribute to these worse outcomes. We investigated ethnic differences in the quality of inpatient stroke care between MAs and NHWs within the population-based prospective Brain Attack Surveillance in Corpus Christi (BASIC) Project (February 2009- June 2012). Quality measures for inpatient stroke care, based on the 2008 Joint Commission Primary Stroke Center definitions were assessed from the medical record by a trained abstractor. Two summary measure of overall quality were also created (binary measure of defect-free care and the proportion of measures achieved for which the patient was eligible). 757 individuals were included (480 MAs and 277 NHWs). MAs were younger, more likely to have hypertension and diabetes, and less likely to have atrial fibrillation than NHWs. MAs were less likely than NHWs to receive tPA (RR: 0.72, 95% confidence interval (CI) 0.52, 0.98), and MAs with atrial fibrillation were less likely to receive anticoagulant medications at discharge than NHWs (RR 0.73, 95% CI 0.58, 0.94). There were no ethnic differences in the other individual quality measures, or in the two summary measures assessing overall quality. In conclusion, there were no ethnic differences in the overall quality of stroke care between MAs and NHWs, though ethnic differences were seen in the proportion of patients who received tPA and anticoagulant at discharge for atrial fibrillation

P1‐567: Cognitive Impairment And Community Resource Needs For Older Mexican Americans: The Brain Attack Surveillance In Corpus Christi (Basic)‐Cognitive Project

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152518/1/alzjjalz2019061172.pd

Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.

OBJECTIVE: To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. DESIGN: Population-based surveillance. SETTING: Corpus Christi, Texas. PATIENTS: All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for do-not-resuscitate orders. Unadjusted and multivariable logistic regression were used to test for associations between ethnicity and do-not-resuscitate orders, both overall ( any do-not-resuscitate ) and within 24 hrs of presentation ( early do-not-resuscitate ), adjusted for age, gender, Glasgow Coma Scale, intracerebral hemorrhage volume, intraventricular hemorrhage, infratentorial hemorrhage, modified Charlson Index, and admission from a nursing home. A total of 270 cases of intracerebral hemorrhage from 2000-2003 were analyzed. Mexican-Americans were younger and had a higher Glasgow Coma Scale than non-Hispanic whites. Mexican-Americans were half as likely as non-Hispanic whites to have early do-not-resuscitate orders in unadjusted analysis (odds ratio 0.45, 95% confidence interval 0.27, 0.75), although this association was not significant when adjusted for age (odds ratio 0.61, 95% confidence interval 0.35, 1.06) and in the fully adjusted model (odds ratio 0.75, 95% confidence interval 0.39, 1.46). Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders written at any time point (odds ratio 0.37, 95% confidence interval 0.23, 0.61). Adjustment for age alone attenuated this relationship although it retained significance (odds ratio 0.49, 95% confidence interval 0.29, 0.82). In the fully adjusted model, Mexican-Americans were less likely than non-Hispanic whites to use do-not-resuscitate orders at any time point, although the 95% confidence interval included one (odds ratio 0.52, 95% confidence interval 0.27, 1.00). CONCLUSIONS: Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders after intracerebral hemorrhage although the association was attenuated after adjustment for age and other confounders. The persistent trend toward less frequent use of do-not-resuscitate orders in Mexican-Americans suggests that further study is warranted

Excess stroke in Mexican Americans compared with non-Hispanic Whites: the Brain Attack Surveillance in Corpus Christi Project.

Mexican Americans are the largest subgroup of Hispanics, the largest minority population in the United States. Stroke is the leading cause of disability and third leading cause of death. The authors compared stroke incidence among Mexican Americans and non-Hispanic Whites in a population-based study. Stroke cases were ascertained in Nueces County, Texas, utilizing concomitant active and passive surveillance. Cases were validated on the basis of source documentation by board-certified neurologists masked to subjects\u27 ethnicity. From January 2000 to December 2002, 2,350 cerebrovascular events occurred. Of the completed strokes, 53% were in Mexican Americans. The crude cumulative incidence was 168/10,000 in Mexican Americans and 136/10,000 in non-Hispanic Whites. Mexican Americans had a higher cumulative incidence for ischemic stroke (ages 45-59 years: risk ratio = 2.04, 95% confidence interval: 1.55, 2.69; ages 60-74 years: risk ratio = 1.58, 95% confidence interval: 1.31, 1.91; ages \u3eor=75 years: risk ratio = 1.12, 95% confidence interval: 0.94, 1.32). Intracerebral hemorrhage was more common in Mexican Americans (age-adjusted risk ratio = 1.63, 95% confidence interval: 1.24, 2.16). The subarachnoid hemorrhage age-adjusted risk ratio was 1.57 (95% confidence interval: 0.86, 2.89). Mexican Americans experience a substantially greater ischemic stroke and intracerebral hemorrhage incidence compared with non-Hispanic Whites. As the Mexican-American population grows and ages, measures to target this population for stroke prevention are critical

The association between bilingual semantic fluency and episodic memory among bilingual Mexican American older adults.

BackgroundBilingualism is increasingly common in older adults in the US and may impact the expression and course of Alzheimer’s Disease and related dementias (ADRD). Optimal methods for assessing cognition in population-based studies of bilingual older adults are not established. Given that declines in semantic fluency are associated with declines in episodic memory in ADRD, we examined the degree to which animal naming in English and Spanish is associated with memory performance in a sample of bilingual Mexican American (MA) older adults.MethodThe Brain Attack Surveillance in Corpus Christi-Cognitive study is a population-based study of cognition in MA and non-Hispanic white adults 65+ in south Texas. We included US-born, bilingual MA participants who completed in-person neuropsychological assessment in their preferred language (English) with the Harmonized Cognitive Assessment Protocol. We added a Spanish animal naming trial to the standard animal naming trial in English. We used the delayed recall score from a word list as the indicator of memory performance. We performed a series of regression analyses with delayed recall as the dependent variable and the English and Spanish animal naming scores as the independent variables, with age, sex, years of education, and a self-reported bilingualism index score to account for level of bilingualism (range 0–1; 0 indicates monolingual Spanish; 1 indicates monolingual English) as covariates.ResultNinety-six participants were included (Mage = 73yrs±6; Meducation = 11±4; 60% women; Table 1). In separate regression models including covariates, English animal naming (b = 0.25, p<.0001) and Spanish animal naming (b = 0.20, p <.05) were each associated with delayed recall. When considered together, English animal naming (b = 0.24, p = <.0001) and not Spanish animal naming (b = 0.03, p = .69) was associated with delayed recall, after accounting for age, sex, years of education, and level of bilingualism (Table 2). Results were consistent when the analysis was restricted to balanced bilinguals (Table 3).ConclusionSemantic fluency in English and Spanish were each related to episodic memory among bilingual MA older adults assessed in English, although the Spanish trial did not add unique information in its association with episodic memory. Future studies should evaluate how bilingual semantic fluency is associated with longitudinal cognitive decline in ADRD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/175536/1/alz065971.pd

Bilingualism, assessment language, and the Montreal Cognitive Assessment in Mexican Americans

Background/ObjectivesAssessment of cognition in linguistically diverse aging populations is a growing need. Bilingualism may complicate cognitive measurement precision, and bilingualism may vary across Hispanic/Latinx sub‐populations. We examined the association among bilingualism, assessment language, and cognitive screening performance in a primarily non‐immigrant Mexican American community.DesignProspective, community‐based cohort study: The Brain Attack Surveillance in Corpus Christi (BASIC)‐Cognitive study.SettingNueces County, Texas.ParticipantsCommunity‐dwelling Mexican Americans age 65+, recruited door‐to‐door using a two‐stage area probability sampling procedure.MeasurementsMontreal Cognitive Assessment (MoCA); self‐reported bilingualism scale. Participants were classified as monolingual, Spanish dominant bilingual, English dominant bilingual, or balanced bilingual based upon bilingualism scale responses. Linear regressions examined relationships among bilingualism, demographics, cognitive assessment language, and MoCA scores.ResultsThe analytic sample included 547 Mexican American participants (60% female). Fifty‐eight percent were classified as balanced bilingual, the majority (88.6%) of whom selected assessment in English. Balanced bilinguals that completed the MoCA in English performed better than balanced bilinguals that completed the MoCA in Spanish (b = −4.0, p  0.10).ConclusionBilingualism is important to consider in cognitive aging studies in linguistically diverse communities. Future research should examine whether cognitive test language selection affects cognitive measurement precision in balanced bilinguals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168453/1/jgs17209.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168453/2/jgs17209-sup-0001-supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168453/3/jgs17209_am.pd

Bilingualism, assessment language, and the Montreal Cognitive Assessment in Mexican Americans

Background/ObjectivesAssessment of cognition in linguistically diverse aging populations is a growing need. Bilingualism may complicate cognitive measurement precision, and bilingualism may vary across Hispanic/Latinx sub‐populations. We examined the association among bilingualism, assessment language, and cognitive screening performance in a primarily non‐immigrant Mexican American community.DesignProspective, community‐based cohort study: The Brain Attack Surveillance in Corpus Christi (BASIC)‐Cognitive study.SettingNueces County, Texas.ParticipantsCommunity‐dwelling Mexican Americans age 65+, recruited door‐to‐door using a two‐stage area probability sampling procedure.MeasurementsMontreal Cognitive Assessment (MoCA); self‐reported bilingualism scale. Participants were classified as monolingual, Spanish dominant bilingual, English dominant bilingual, or balanced bilingual based upon bilingualism scale responses. Linear regressions examined relationships among bilingualism, demographics, cognitive assessment language, and MoCA scores.ResultsThe analytic sample included 547 Mexican American participants (60% female). Fifty‐eight percent were classified as balanced bilingual, the majority (88.6%) of whom selected assessment in English. Balanced bilinguals that completed the MoCA in English performed better than balanced bilinguals that completed the MoCA in Spanish (b = −4.0, p  0.10).ConclusionBilingualism is important to consider in cognitive aging studies in linguistically diverse communities. Future research should examine whether cognitive test language selection affects cognitive measurement precision in balanced bilinguals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/168453/1/jgs17209.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168453/2/jgs17209-sup-0001-supinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/168453/3/jgs17209_am.pd