Kenton Award Lecture—Stroke Disparities Research: Learning From the Past, Planning for the Future

Abstract

Inequities in stroke care and outcomes have been documented both within and among countries based on factors, such as race, geography, and socioeconomic status. Research can help us to identify, understand, and address inequities, and this article offers considerations for scientists working in this area. These include designing research aimed at identifying the underlying causes of inequities, recognizing the importance of the social determinants of health, considering interventions that go beyond the individual patient and provider to include policies and systems, acknowledging the role of structural racism, performing community-engaged participatory research, considering intersecting social identities, learning from cross-national comparisons, maintaining the data sources needed for inequities research, using terminology that advances health equity, and improving diversity across the research enterprise.

Health Equity and Actionable Disparities in Stroke: 2022 Update

“…Sarfo et al make a case for both the efficacy and cost-effectiveness of polypill interventions for cardiovascular disease prevention; however, highlight the importance of using implementation science to determine barriers to systematic implementation of such interventions. The reviews by Reeves et al, 2 Sharrief et al 3 , and Sarfo et al highlight several of the considerations in Kapral’s 1 framework for the future of research addressing stroke inequities. Specifically, in all interventions discussed—care transitions, telehealth, and polypills—social determinants of health need to be addressed or considered to reduce inequities.…”

“…Her article, entitled Kenton Award Lecture—Stroke Disparities Research: Learning From the Past, Planning for the Future, provides a roadmap to addressing inequities in stroke. 1 Kapral delineates 10 considerations for scientists performing research in stroke inequities. First, it is critical to develop a sound understanding of the underlying causes of inequities.…”

“…Established in 2020, it is the first annual multidisciplinary scientific forum focused on inequities in cerebrovascular disease, with the overarching goal of accelerating translation of research findings to practice, to reduce inequities. The symposium aims are (1) to provide opportunities for researchers from diverse scientific and professional disciplines to discuss cuttingedge research about inequities in stroke and identify knowledge gaps for further research; (2) to accelerate collaborations among stakeholders interested in addressing stroke inequities; (3) to provide career development opportunities for underrepresented in medicine trainees and junior investigators, and (4) to disseminate knowledge generated from the symposium.…”

Understanding gender inequity in brain health outcomes: missed stroke as a case study for intersectionality

“…More recently though, we see significant geographic differences and a multiplicity of factors underlying in gender inequity in the detection of stroke ( 22 ) as well as increasing sex-based parity within time trends in endovascular therapy ( 23 ). Gender bias-based “knowledge gaps” ( 24 ) are variable in how they translate to clinical disparities in prevention, diagnosis, post-stroke care and secondary outcome within the dynamic relationships between age, gender, ethnoracial identity, language and nationality ( 25 , 26 ).…”

“…First, a more nuanced understanding of challenges entering stroke pathways is needed, including the ways that misdiagnosis in stroke among minoritized groups impacts downstream care. The field needs to move beyond incidence rates for discrete demographic groups and understand differences within groups are being mediated by aspects of identity that are impacted by structural disadvantage ( 26 , 34 ). The tendency to misdiagnose a stroke does not necessarily stem from a lack of technological advancements or incompetency among healthcare professionals.…”