Holloway agreed. "We can't exclude that possibility," he said. "But there is something going on that is more than just small vessel versus large vessel -- there is something more there. My gut tells me [the care they are getting] has to be part of the explanation."
The report is published in the Feb. 1 issue of the Annals of Internal Medicine.
For the study, Holloway's team collected data on 5,319 black patients and 18,340 white patients hospitalized for stroke from January 2005 to December 2006.
During follow-up, 5 percent of the black patients died in the hospital, compared with 7.4 percent of the white patients. After 30 days, 6.1 percent of the black patients died from any cause, compared with 11.4 percent of the white patients, the researchers found.
After one year, 16.5 percent of the black patients had died, compared with 24.4 percent of the white patients, they reported.
In addition, black patients were 22 percent more likely to receive more aggressive care than whites.
Moreover, compared with white patients, black patients were 75 percent less likely to be admitted to a hospice after leaving the hospital, Holloway's group found.
Holloway thinks these findings are important, especially in light of the new paradigm called patient-centered care. How care options are explained and decisions about care are made have become areas that need to be better understood, he said. This includes how patients and their families make these decisions, he added.
"There is a lot of policy now that uses 30-day mortality as a measure of quality," he said. The question is "are there incidences when you have a well-informed patient who decides to forgo life-sustaining interventions -- that has a higher mortality, but it could be excellent quality," Holloway said. "Using 30-day mortality as a measure of quality may not be as simple as it sounds."
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