Racial disparities in moyamoya disease in a North American cohort
Irshad K, Malik S, and Schultz L. Racial disparities in moyamoya disease in a North American cohort. Neurology 2019; 92(15).
Objective: To review characteristics of patients presenting with moyamoya disease (MMD) to an urban tertiary center in North America. Background: The etiology, demographic variables and patterns of disease in African Americans (AA) compared to Caucasians (CA) is still not fully understood. Design/Methods: Retrospective analysis of patients presenting to our institution from 1995 to 2016 was performed. ICD9/10 codes for MMD were confirmed. We reviewed 252 patients, 181 were excluded due to other diagnosis. Chart review was conducted on 71 patients with angiographically confirmed MMD. SAS version 9.4 was used. AA and CA patients were reviewed using chi-squared tests for categorical variables and two-sample test for age. Results: Of 71 MMD cases, 29 were AA, 30 CA, 1 Asian, 11 had race coded as unknown. Most were female (68% AA and 73% CA). Mean age of onset was about the same, 34.1 and 35.6 years. The most common symptom was unilateral weakness (23%). AA's had a significantly lower rate of transient ischemic attacks (TIA) compared to CA (7% vs 27%, p=0.049). AA's were noted to have higher rates of weakness (32% vs 13%, p=0.086). 6 patients had intracerebral hemorrhage of which, 5 were AA. Most common risk factor was hypertension which was higher in AA (56% vs 38%). Hyperlipidemia (41% vs 31%) was also higher in AA. Smoking (52% vs 44%), diabetes (24% vs 15%) and coronary artery disease (10% vs 7%) were higher in CA. AA's had significantly higher rates of receiving medical treatment compared to CA's (86% vs 60%, p=0.029) and a lower rate of receiving surgery, which was not significant (32% vs 43%, p=0.38). Conclusions: Our study revealed a lower rate of TIAs and a higher rate of receiving medical therapy in AA which could be due to different socioeconomic factors. Studies are needed to understand MMD in different races.