PubMed · 9060280
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C A Miller. Identify adverse medication effects when assessing function.. https://doi.org/10.1016/s0197-4572(96)80247-3
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To assess black-white differences in disability and morbidity in the last years of life, the authors analyzed data from the National Health Interview Survey from 1986 to 1994, with mortality follow-up through December 1995. A baseline household interview was conducted for 10,187 decedents aged 50 years and over within 2 years before death. Data collected included long-term limitation of activity, number of chronic conditions, number of bed days, doctor visits, and days of short hospital stay during the year preceding the interview. For both blacks and whites, educational attainment was inversely associated with disability/morbidity indices. Black decedents had greater morbidity compared with whites, and this difference was consistent across educational levels. Adjustment for education reduced the black-white difference in limitation of activity score by 32%, bed days by 59%, and hospital stay days by 40%. This study from a national representative US sample indicates that black decedents experienced greater disability/morbidity and worse quality of life through their last few months or years of life. Educational attainment was associated with morbidity before death and accounted for much of the black-white difference.
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BACKGROUND: In 1995, the two-part National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator Stroke Trial found that patients who were treated with tissue plasminogen activator (t-PA) within three hours after the onset of symptoms of acute ischemic stroke were at least 30 percent more likely than patients given placebo to have minimal or no disability three months after the stroke. It was unknown, however, whether the benefit would be sustained for longer periods. METHODS: In the NINDS Trial, a total of 624 patients with stroke were randomly assigned to receive either t-PA or placebo. We collected outcome data over a period of 12 months after the occurrence of stroke. The primary outcome measure was a "favorable outcome," defined as minimal or no disability as measured by the Barthel index, the modified Rankin Scale, and the Glasgow Outcome Scale. We assessed the treatment effect using a global statistic. RESULTS: Using an intention-to-treat analysis for the combined results of the two parts of the trial at 6 months and 12 months, we found that the global statistic favored the t-PA group (odds ratio for a favorable outcome at 6 months, 1.7; 95 percent confidence interval, 1.3 to 2.3; odds ratio at 12 months, 95 percent confidence interval, 1.7; 1.2 to 2.3). The patients treated with t-PA were at least 30 percent more likely to have minimal or no disability at 12 months than were the placebo-treated patients (absolute increase in the proportion with a favorable outcome, 11 to 13 percentage points). There was no significant difference in mortality at 12 months between the t-PA group and the placebo group (24 percent vs. 28 percent, P=0.29). There was no interaction between the type of stroke identified at base line and treatment with respect to the long-term response. The rate of recurrent stroke at 12 months was similar in the two groups. CONCLUSIONS: During 12 months of follow-up, the patients with acute ischemic stroke who were treated with t-PA within three hours after the onset of symptoms were more likely to have minimal or no disability, than the patients given placebo. These results indicate a sustained benefit of t-PA for such patients.