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Background and Purpose— Although poststroke depression is common, racial–ethnic disparities in depression among stroke survivors remain underexplored. Thus, we investigated the relationship between race/ethnicity and depression in a multiracial–ethnic stroke cohort. Methods— Baseline survey data of validated scales of depression and functional status, demographics, comorbidities, and socioeconomic status were used from a recurrent stroke prevention study among community-dwelling urban stroke/transient ischemic attack survivors. Results— The cohort included 556 participants with a mean age of 64 years. The majorities were black (44%) or latino (42%) and female (60%), had their last stroke/transient ischemic attack nearly 2 years before study enrollment, and lived below the poverty level (58%). Nearly 1 in 2 latinos, 1 in 4 blacks, and 1 in 8 whites were depressed. Multivariate logistic regression showed that survivors who were younger, were female, had ≥3 comorbid conditions, were functionally disabled from stroke, lacked emotional–social support, and who took antidepressants before study entry had higher risk of depression. Time since last stroke/transient ischemic attack did not affect the chance of depression. After adjusting for all above risk factors, latinos had 3× the odds of depression (95% confidence interval: 1.18–6.35) than whites; blacks and whites had similar odds of depression. Conclusions— This study reveals that latino stroke survivors have a significantly higher prevalence of depression compared with their non-latino counterparts.

Background: Social isolation is associated with increased vascular events post stroke, but the role of living arrangements versus social networks on stroke outcomes has not been well explored. We aim to characterize these associations overall and by race-ethnicity. Methods: The Stroke Warning Information and Faster Treatment (SWIFT) study tested a stroke preparedness intervention on arrival times for stroke/TIA recurrence to the ED. Stroke/TIA patients able to consent were prospectively recruited and randomized. Baseline data collection included demographics, medical history, socioeconomic status (SES), and social support networks. Living arrangements were categorized as living alone, living with one or 2 people, or living with three or more people (dense household). Weak social support networks defined as 4 or less family or friend visits in past week. Participants were followed for a mean of 2.9 years. An outcome of vascular event was defined as stroke, TIA, MI, or death post enrollment. Multivariate logistic regression models examined the relationship between vascular outcomes, living arrangements and social support networks adjusting for demographics, health and SES. Results: Between 2005 and 2009 1193 participants were enrolled: mean age 63 years; 51% Hispanics, 26% whites, and 17% Blacks; 50% female; and 42% < high school education. Over 24% lived alone, 23% lived with spouse/partner only, and 21% lived in dense households. In adjusted logistic models, post stroke vascular events were associated with dense households [RR 1.5 (95% CI: 1.1 - 1.9)], and weak family networks [RR 1.9 (95% CI: 1.4 - 2.8)]. Stratifying by race-ethnicity, the results remained significant for Hispanics where dense households [RR 1.9 (95% CI: 1.3 - 2.6)], weak family networks [RR 2.8 (95% CI: 1.5 - 5.1)], and weak friend networks [RR 1.5 (95% CI: 1.0 - 2.5)] increased vascular events post stroke. Conclusion: Living in dense households can increase risk of vascular events post stroke, while stronger social support networks can decrease this risk especially among Hispanic stroke survivors. Future research is needed to explore the mechanism of these associations and to identify possible racial/ethnic tailored interventions based on living arrangements and social networks.

Background: Hypertension is a major risk factor for stroke recurrence but it is poorly controlled among stroke survivors, particularly from minority groups. The Prevent Recurrence of All Inner-city Strokes through Education (PRAISE) trial tests whether a community-based, peer-led stroke education intervention improves stroke risk factors, primarily blood pressure control. Methods: Using community-based participatory research, clinicians, educators and stroke survivors developed a six-session peer-led workshop to help stroke survivors understand their illness, and identify and manage their recurrent risks, particularly hypertension. We recruited 600 individuals with a history of stroke or TIA within the past 5 years who were randomized to the intervention or a wait-list control group. At baseline, 6 and 12 months, we measured participants’ blood pressures, socio-demographics, beliefs and behaviors. Six-month data collection has been completed. Results: Participants have a mean of 63 years, the majority are female (60%), Black or Latino (81%) and live in poverty (56%). At baseline, 31% in both groups had uncontrolled blood pressure ( Conclusions: A peer-led educational program developed through a community-academic partnership was successful in improving blood pressure control at 6 months. While 12-month data will confirm the longevity of this impact, PRAISE is simple, culturally appropriate and inexpensive, and may represent an important and sustainable secondary stroke prevention strategy.

Background: Literature suggests that White Americans experience more depression in general, and post-stroke depression than non-White Americans, but depression disparities have not been well-explored. We aimed to characterize this association by applying a novel ‘Rank and Match’ secondary analytic method, based on the Institute of Medicine’s disparity framework to a multi-racial/ethnic stroke cohort. Methods: We recruited a cohort of community-dwelling adults who had a stroke in the past 5 years, from Harlem and the South Bronx in New York City, to a recurrent stroke prevention intervention. At baseline, we measured depression using the PHQ-8 scale and patients’ health status, demographics, comorbidities and socioeconomic status (SES), including income and education. We used multivariate logistic regression to evaluate the impact of race/ethnicity, after adjusting for health status and SES, on having depression (using a score ≥ 10 as depressed). Then based on the IOM’s disparity framework, we used our "Rank and Match" method to assess racial/ethnic differences in depression after matching Latinos and non-Latinos by their health status rank. Results: The cohort included 600 participants, with a mean of 1.9 years after stroke, mean age of 63 years, 42% were Black, 39% Latino, 60% female, 56% lived below poverty, 29% had Medicaid and 31% had less than a high school degree. Participants with depression (n=178; 30%) were more likely young (p=0.002), Latino (p Conclusion: This study newly reveals a high depression burden among Latino stroke survivors, particularly in comparison with non-Latinos. Future research is needed to further study this disparity, and to address depression in this population.

INTRODUCTION: Demographic disparities in recurrent events among stroke survivors have received some attention, but little is known about the impact of gender. We explored whether gender was associated with having a recurrent event, after accounting for health status and SES, in a multi-ethnic stroke cohort. METHODS: The Stroke Warning Information and Faster Treatment study (SWIFT) was a randomized stroke preparedness educational intervention, which prospectively enrolled mild and moderate stroke/TIA patients able to sign informed consent and identified at the NY Presbyterian Medical Center from 2005 to 2010. We defined a recurrent event as having ≥1 of the following post-enrollment: a stroke, TIA, MI, death, migraine, or significant stroke mimic. Gender was dichotomous. Health status included age, race/ethnicity, comorbidities, and CVD history. SES included education, employment, and insurance. We conducted chi-squared tests and t-tests. We used multiple logistic regression to assess the impact of gender, after adjustment for health status and SES, on having a recurrent event. Effect modification of the adjusted gender difference by race/ethnicity was also examined. RESULTS: The cohort included 1203 patients, of which 31% (n=375) had 580 recurrent events. Intervention was not associated with gender (p=0.35) nor having a recurrent event (p=0.07). Females (n=596, 49.5%) were older (p=0.002), had a higher proportion of comorbid hypertension (p=0.019), had less non-Hispanic Whites (p=0.028), were less educated (p=0.022), and had more Medicaid recipients (p CONCLUSION: While age has historically been suggested as an explanation for poorer functional scores post stroke, the nature of these recurrent events among women with milder stroke/TIA and its intersection with race/ethnicity needs further exploration.

Background Stroke survivors may be at increased risk for post-traumatic stress disorder (PTSD), yet detailed data on prevalence and contributing factors are lacking. Harlem residents and local researchers, alarmed by high rates of stroke in their community and frustrated by the difficulty of engaging stroke survivors in prevention programs, aimed to determine the prevalence and correlates of PTSD in a cohort of survivors of stroke and transient ischemic attack (TIA). Methods Harlem residents and researchers employed community-based participatory research to develop a recurrent stroke prevention intervention. English and Spanish speaking adults over 40 were eligible for inclusion if they reported a stroke or TIA within the past five years. Baseline assessments included blood pressure, direct LDL cholesterol and validated self-report scales for demographics, stroke impact (modified Rankin scale), medical co-morbidities (Charlson co-morbidity index), and the widely-used 17-item PTSD Checklist Specific for stroke (PCL-S). A PCL-S score of 25 connotes a positive screening test, while a score greater than 50 is highly specific for PTSD. We recruited participants from community and clinical sites. To create a model of correlates for PTSD (PCL-S score > 50), we used logistic regression. Results The 379 enrollees had a mean age of 64 years, 62% were women, 79% were Black or Latino, 28% never completed high school, and more than half earned under $15,000 yearly. Most (75%) had PCL-S scores greater than 25, including 69 (18%) who scored above 50. Using logistic regression, and controlling for gender, race, education, and income (c-statistic of 0.835, p 100 mg/ dl (59% vs. 39%, p=0.003), both major risk factors for recurrent stroke. There was no significant difference in blood pressure control between the patients with and without PTSD. Conclusion PTSD is common after stroke, especially in younger people with more disability and more co-morbidity. We recommend that clinicians screen patients for PTSD after stroke and offer supportive therapy.