Ethnic Disparities in Stroke

Stansbury, James P.; Jia, Huanguang; Williams, Linda S.; Vogel, William; Duncan, Pamela W.

doi:10.1161/01.str.0000153065.39325.fd

Cited by 242 publications

(134 citation statements)

References 98 publications

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“…Several other studies of knowledge of stroke risk factors and warning signs also show consistent racial disparities. 8,9,13,14 Similar to prior reports on knowledge of stroke risk factors and warning signs, we also found that tPA awareness was lower in the oldest age groups who are at the greatest risk of stroke. 7 Limitations of this study include those associated with the Behavioral Risk Factor Survey and other random digit dial surveys.…”

Section: Discussionsupporting

confidence: 88%

Knowledge of Tissue Plasminogen Activator for Acute Stroke Among Michigan Adults

Anderson

Rafferty

Lyon-Callo

et al. 2009

Stroke

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Background and Purpose-Although tissue plasminogen activator (tPA) is an effective therapy for acute ischemic stroke, treatment rates remain low. Efforts to address the underuse of tPA include public education to increase the recognition of stroke symptoms and the awareness of tPA treatment. Our objective was to determine the level of knowledge about tPA treatment for acute stroke among a representative sample of Michigan adults. Methods-The Michigan Behavioral Risk Factor Survey (BRFS) is a random-digit-dial telephone survey of adults conducted annually as part of the national BRFS. Questions regarding tPA treatment for acute stroke were included in the 2004 Michigan BRFS. We examined the prevalence of awareness using 2 tests and generated multivariable logistic regression models. Results-Among 4724 respondents, only 32.2% (95% CIϭ30.8 to 33.8%) were aware of the existence of tPA treatment for acute stroke, of whom 52.7% (50.0 to 55.4%) knew that it needed to be administered within 3 hours of symptom onset. Awareness of tPA was higher among middle aged adults, females, whites, and those with higher education and income. Awareness of the time window for tPA was higher among middle aged adults and whites. Conclusions-In this population-based survey only a third of the public were aware of tPA as a treatment for stroke, and only 1 in 6 were aware that the treatment exists and needs to be given within 3 hours of symptom onset. Continuing efforts are necessary to increase public knowledge about tPA treatment for acute stroke.

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Section: Discussionsupporting

confidence: 88%

Knowledge of Tissue Plasminogen Activator for Acute Stroke Among Michigan Adults

Anderson

Rafferty

Lyon-Callo

et al. 2009

Stroke

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“…A greater burden of stroke incidence and mortality for black and Hispanic patients has been established in the literature, though reasons for this disparity are unclear 36, 37, 38, 39. Few studies have looked at presentation to PSCs by race and ethnicity 18, 40.…”

Section: Discussionmentioning

confidence: 99%

“…There may be differences in stroke severity or other rt‐PA inclusion/exclusion criteria across racial groups. Black and Hispanic stroke patients present at younger ages,39, 45 and younger patients tend to suffer milder strokes, by National Institutes of Health Scale 46, 47. This could lead to withholding rt‐PA because of either diagnostic uncertainty or a low perceived likelihood of disability from the presenting symptoms, yet, in 1 multicenter study of young adults with stroke, black patients suffered worse 30‐day mortality and functional outcomes compared to white patients 48.…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Aparicio

Carr

Kasner

et al. 2015

JAHA

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BackgroundPrimary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt‐PA) than non‐PSCs. The impact of PSCs on racial disparities in rt‐PA use is unknown.Methods and ResultsWe used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt‐PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to PSCs. A higher proportion received rt‐PA at PSCs than non‐PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P<0.001). In a multivariable model adjusting for year, age, sex, insurance, medical comorbidities, a diagnosis‐related group–based mortality risk indicator, ZIP code median income, and hospital characteristics, blacks were less likely to receive rt‐PA than whites at non‐PSCs (odds ratio=0.58, 95% CI 0.50 to 0.67) and PSCs (odds ratio=0.63, 95% CI 0.54 to 0.74) and Hispanics were less likely than whites to receive rt‐PA at PSCs (odds ratio=0.77, 95% CI: 0.63 to 0.95). In the fully adjusted model, interaction between race and presentation to a PSC for likelihood of receiving rt‐PA did not reach significance (P=0.98).ConclusionsRacial disparities in intravenous rt‐PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non‐PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt‐PA in the fully adjusted model.

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“…Mary Cushman ve ark., Afrika kökenli Amerikalılarda beyazlara göre strok riskinin aynı yaş grubu ve cinsiyette % 11.3'e % 9.7 oranında daha yüksek olduğunu belirtmektedirler (22). Irklar arasında; diyabet, sistolik kan basıncı, sol ventrikül hipertrofisi, sigara içme oranında da farklılıklar bildirilmiştir (23,24,25). Kenneth J.…”

Section: Derleme Reviewunclassified

Prognostic Factors of Stroke: the review of factors related to patient

Duman¹,

Dede²

2010

Türk Beyin Damar Hast Derg

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ÖZETNöroloji kliniklerinin en sık karşılaşılan hastalığı olan serebrovasküler hastalıklar, yuksek morbidite ve mortalite kaynağı olması nedeniyle önem taşımaktadır (1). Önemli olduğu oranda, tedavi güçlükleri ve hastalığın ilerleyiş öngörüsünün net olmaması nedeniyle karmaşıktır (2). Serebrovasküler hastalıklar ile uğraşan hekimler, tedavilerine yön verebilmek, hastalığa ilişkin beklentileri belirlemek ve hastalığın gidişini pozitif yönde modifiye edebilmek için prognoz hakkında öngörü sahibi olmak isterler. Serebrovasküler hastalıkların prognozunu belirleyebilmek için tanımlanmış birçok değişken bulunmaktadır. Serebrovasküler hastalık prognozunu belirlemede hekime rehberlik edecek değişkenler; hastaya bağlı, hastalık kliniğine bağlı , tanısal yönteme ve tedavi yaklaşımına bağlı olan değişkenler olarak belirlenmiştir. Hastaya ait değişkenler içinde; yaş, cinsiyet, etnik özellikler, eğitim düzeyi, aile öyküsü, risk faktörleri (atriyal fibrilasyon , hipertansiyon, hiperglisemi, ateroskleroz, vaskülit, hiperfibrinojenemi gibi), aile ve sosyal çevrenin desteği, genetik etkenler ve biyomarkerlar vardır. Serebrovasküler hastalıklarda prognoza ilişkin faktörlerin incelendiği derlemenin bu ilk bölümünde, hastaya ait prognostik faktörler gözden geçirilmiş ve bu konudaki çalışmaların bir kısmı karşılaştırmalı olarak incelenmiştir. Anahtar Sözcükler: Prognoz, stroke, iskemi, hipertansiyon, hiperglisemi PROGNOSTIC FAKTORS OF STROKE: THE REVIEW OF FACTORS RELATED TO PATIENTS ABSTRACTCerebrovascular diseases, the most frequently encountered diseases of neurology clinics, are important because they cause high morbidity and mortality rates (1). As well as being important, they are also complex diseases since they are difficult to treat and the prevision of their progression is vague (2). Doctors who are dealing with cerebrovascular diseases need to anticipate the prognosis in order to direct the treatment and to modify the expectations of the patient's relatives. Inquiries and problems of the patients and their relatives can be guided through sound responses in the future. There are various variables defined to determine the prognosis of cerebrovascular diseases. The variables that will guide the doctor in the determination of the prognosis depending on the patients, the medical clinic, diagnostic methodology and treatment approach. The age, the gender, ethnicity, educational level, family history, elements of risk (atrial fibrillation, hypertension, hyperglycemia, atherosclerosis, vasculitis, fibrinogenemia etc.) of the patient, the family and social support, genetics and biomarkers are the variables depending on the patient. Characteristics of the lesion; localization and its extents are the variables depending on the diseas. Motor deficits, aphasia, anosognosia, dementia, urinary incontinence, presence of sleep disorder, the improvement rate of the symptoms are the variables of clinics of the stroke. Monitoring methods are the variables of diagnostics. Antiaggregant and thrombolytic treatment, cognitive therapy constitutes t...

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Ethnic Disparities in Stroke

Cited by 242 publications

References 98 publications

Knowledge of Tissue Plasminogen Activator for Acute Stroke Among Michigan Adults

Knowledge of Tissue Plasminogen Activator for Acute Stroke Among Michigan Adults

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Prognostic Factors of Stroke: the review of factors related to patient

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