Mexican American Immigrants Demonstrate Better Functional Stroke Outcomes Compared With Mexican American Nonimmigrants

Abstract

Background and purpose: We analyzed differences in 90-day poststroke outcomes between Mexican Americans born in the United States (nonimmigrant) compared with those born outside the United States (immigrant).

Methods: We performed a retrospective analysis of prospective data from the population-based Brain Attack Surveillance in Corpus Christi project. We identified stroke cases from 2008 to 2016 and quantified functional, cognitive, and neurological outcomes. Associations between outcome scores and immigration status were analyzed using weighted linear regression models.

Results: Eighty-three Mexican American stroke cases (n=935) were immigrants, and 852 stroke cases were nonimmigrants. Average length of stay in the United States for immigrants was 47 years. Immigrants were older (69 versus 66 years), more likely men (60% versus 49%), had less education on average, and were more likely to have atrial fibrillation compared with nonimmigrants. No differences in other comorbidities existed between groups. After adjustment for confounders, immigrants had better functional outcomes (activities of daily living/instrumental activities of daily living; mean difference, -0.22; P=0.02; 1-4, higher scores worse) and no difference in neurological outcomes (log-National Institutes of Health Stroke Scale; mean difference, -0.15; P=0.15; 0-44, higher scores worse) or cognitive outcomes (3 Mini-Mental State Examination; mean difference, -0.79; P=0.64; 0-100, lower scores worse).

Conclusions: Long-term Mexican American immigrants in this community display better stroke functional outcomes than nonimmigrant Mexican Americans and comparable neurological and cognitive outcomes.

Keywords: Hispanic Americans; emigrants and immigrants; ethnic groups; stroke.

Figure 1.. Sequential adjustment of outcomes.

Model 1: No adjustment; Model 2: Adjusted for age quartiles, sex, initial NIH stroke scale score; Model 3: Model 2 + hypertension, diabetes, atrial fibrillation, dementia or Alzheimer’s, myocardial infarction or coronary artery disease, smoking status, received IV tPA, categorical body mass index, education; Model 4: Model 3 + insurance status. ADL/IADL=Activities of Daily Living/Instrumental Activities of Daily Living; NIHSS=National Institutes of Stroke Scale; MSE=Mini-mental status exam.