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AHA Statement Notes Disparities in Stroke Care in the United States


A scientific statement from the American Heart Association/American Stroke Association, published online in Stroke: Journal of the American Heart Association, notes disparities between racial/ethnic minorities and whites cross all aspects of stroke care.

The American Heart Association Stroke Council Scientific Statement Oversight Committee appointed a writing committee represented different areas of expertise in relation to racial-ethnic disparities in stroke care who were tasked with reviewing relevant literature, emphasizing reports published since 1972.

The comprehensive analysis looked at the role of race and ethnicity in stroke care and its impact on the numbers of people who have a stroke, live with its effects or die among minority groups compared to whites. It also addresses how access to care, response to treatment and participation in clinical research affects these groups.

"We see disparities in every aspect of stroke care, from lack of awareness of stroke risk factors and symptoms to delayed arrival to the emergency room and increased waiting time," said Salvador Cruz-Flores, M.D., M.P.H., lead author of the statement and professor of neurology and director of the Souers Stroke Institute at St. Louis University in Missouri. "These disparities continue throughout the spectrum of the delivery of care from acute treatment to rehabilitation."

Hispanic-Americans, African-Americans, Asian-Americans and Native-Americans constitute 28% of the U.S. population and is expected to almost double by the year 2050. This makes it increasingly important to reduce racial and ethnic disparities in health care.

The review also included Alaskan Natives, and Native Hawaiians/other Pacific Islanders.

The incidence and prevalence of stroke are higher among blacks or African Americans, Hispanics, and American Indians/Alaskan Natives than among whites. This difference is more marked at a younger age. Recurrent stroke risk is also higher among blacks or African Americans and Hispanics.

The highest burden is among blacks or African Americans. In addition, blacks or African Americans have greater impairment after a stroke.

The burden of risk factors is different among racial and ethnic groups according to the statement. For example, African-Americans have a high prevalence of hypertension, diabetes and obesity as well as other risk factors for stroke, while Hispanic-Americans have a high prevalence of metabolic syndrome and diabetes compared to whites and African-Americans. The metabolic syndrome is a cluster of risk factors that include three or more of the following: elevated waist circumference, elevated triglycerides, reduced good cholesterol, elevated blood pressure and elevated fasting glucose.

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Other factors that impact these disparities range from economic and social issues to cultural and language barriers. In addition, attitudes, beliefs and compliance among populations differ and the perceived or true presence of racial bias within the healthcare system can negatively impact a patient's compliance with a healthcare provider's advice, medications or treatment, according to the statement.

"It is important for members of ethnic and racial minority groups to understand they are particularly predisposed to have risk factors for heart disease and stroke," Cruz-Flores said. "They need to understand these diseases are preventable and treatable."

Educating the public and healthcare community can improve stroke care for minorities, he said.

Education of stroke warning signs is another area needed as the committee noted knowledge of stroke warning signs among the general population is poor, with 30% to 60% of the population being unable to recognize a single stroke warning sign and only 20% to 40% capable of recognizing 5 symptoms and indicating that they would call 9-1-1 if they thought someone was having a stroke.

Blacks or African Americans and Hispanics from the central Harlem (NY) area were noted to achieve a substantially lower score than whites on a questionnaire about basic stroke knowledge.

The 5 warning signs of stroke all should know include:

  1. Walk — Is their balance off?
  2. Talk — Is their speech slurred or face droopy?
  3. Reach — Is one side weak or numb?
  4. See — Is their vision all or partly lost?
  5. Feel — Is their headache severe?

It a person is experiencing any of these, 9-1-1 should be called.

Some of the statement recommendations include:

  1. Development of public health policies to close the gap between minorities and whites in all aspects of stroke prevention, incidence and care;
  2. More education and research to reduce disparities in stroke care;
  3. Increased access to insurance coverage in minority populations; and
  4. More research on American Indians, Asian Americans and Pacific Islanders.

"It is striking that we are in the 2lst century, with many advances in stroke care, yet we are still struggling to fix the differences that are present not only in the distribution of the disease but also in the level of care we provide to the different racial and ethnic groups," Cruz-Flores said.

The above story is includes adapted information from the American Heart Association news release.

Racial-Ethnic Disparities in Stroke Care: The American Experience: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association; Salvador Cruz-Flores, M.D., M.P.H., et al; Stroke, published online May 26, 2011; DOI: 10.1161/STR.0b013e3182213e24