Racial Disparities in Stroke Recurrence

Robinson, David; Stanton, Robert J.; Sucharew, Heidi; Alwell, Kathleen; Haverbusch, Mary; Rosa, Felipe De Los Rios La; Ferioli, Simona; Coleman, Elisheva; Jasne, Adam; Mackey, Jason; Star, Michael; Mistry, Eva; Demel, Stacie L; Slavin, Sabreena; Walsh, Kyle B; Woo, Daniel; Kissela, Brett M.; Kleindorfer, Dawn

doi:10.1212/wnl.0000000000201225

Cited by 20 publications

(15 citation statements)

References 49 publications

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“…Among young Black patients with stroke, racial disparities in incidence are not fully explained by prevalence of these traditional risk facts and remain poorly understood. 22 There is abundant literature regarding disparities in time to acute treatment, with minoritized groups experiencing delays in presenting to care. 29 Black and Latino patients are more likely to present as "walk-in" cases, perhaps related to fear of ambulance costs.…”

Section: Strokementioning

confidence: 99%

Racial and Ethnic Disparities in Neurological Care in the United States

Perez,

Reyes-Esteves,

Mendizabal

2024

Semin Neurol

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The burden of neurological disease is increasing globally. In the United States, this burden is disproportionally greater for Black and Latino communities who have limited access to neurological care. Health services researchers have attempted to identify racial and ethnic disparities in neurological care and possible solutions. This article reviews the most current literature on racial and ethnic disparities in commonly encountered neurological conditions, including Stroke, Alzheimer's Disease, Multiple Sclerosis, Epilepsy, Parkinson's Disease, and Migraine. Disparities exist in disease incidence, diagnosis, access to care, treatment, outcomes, and representation in epidemiologic studies and clinical trials. Many of the disparities observed in neurological care in the United States are a consequence of longstanding racist and discriminatory policies and legislation that increase risk factors for the development of neurological disease or lead to disparities in accessing quality neurological care. Therefore, additional efforts on the legislative, community health, and healthcare system levels are necessary to prevent the onset of neurological disease and achieve equity in neurological care.

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Section: Strokementioning

confidence: 99%

Racial and Ethnic Disparities in Neurological Care in the United States

Perez,

Reyes-Esteves,

Mendizabal

2024

Semin Neurol

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“…Approximately 1.3 million people live in this region of the United States. 5 Patients who had a first-time stroke in 2014 or 2015 were then followed up over a 3-year period, and the researchers looked for occurrences of repeat or recurrent stroke. The authors evaluated the participants' past illnesses and risk factors of stroke.…”

Section: How Was the Study Performed?mentioning

confidence: 99%

“…If there are differences among diverse groups, can we understand why repeated stroke is more common for some groups than others? It was in hopes of answering these questions that Dr. Robinson et al initiated the study, “Racial Disparities In Stroke Recurrence: A Population-Based Study.” 5…”

mentioning

confidence: 99%

The Risk of a Second Stroke

Karceski¹

2022

Neurology

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In the United States, it is estimated that 800,000 people will have a stroke each year. Of these, approximately 600,000 are first-time strokes, which means that approximately one-fourth or 200,000 will have a repeated stroke. This means that every 40 seconds, someone in the United States has a stroke. Once in every 3.5 minutes, someone dies of stroke (CDC website). The yearly cost of stroke in the United States is estimated at $45 billion1 to $53 billion.2 Because stroke mostly affects older individuals (two-thirds of stroke occurs in individuals older than 65 years), as our population grows older, the rates of stroke, and its cost, will increase.

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“…7,8 Furthermore, after an ischemic stroke, non-Hispanic Black and Hispanic patients have a higher risk of recurrent stroke. [9][10][11] Similarly, non-Hispanic Black and Hispanic patients also experience a higher risk of both, incident and recurrent ICH. [12][13][14][15][16] However, it is unclear if there are racial and ethnic disparities in the risk of ischemic stroke after ICH.…”

mentioning

confidence: 99%

Racial and Ethnic Differences in the Risk of Ischemic Stroke After Nontraumatic Intracerebral Hemorrhage

Simonetto

Sheth

Ziai

et al. 2023

Stroke

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BACKGROUND: Intracerebral hemorrhage (ICH) is associated with an increased risk of ischemic stroke. Whether there are racial and ethnic disparities in the risk of ischemic stroke after ICH is poorly understood. We therefore aimed to test the hypothesis that non-Hispanic Black and Hispanic ICH patients have a higher risk of ischemic stroke compared with non-Hispanic White ICH patients. METHODS: We performed a retrospective cohort study using the Healthcare Cost and Utilization Project (HCUP) on all hospitalizations at all nonfederal hospitals in Florida from 2005 to 2018 and New York from 2006 to 2016. Race and ethnicity were coded as a single variable in HCUP. We included patients with an ICH, and without a prior or concomitant diagnosis of ischemic stroke, ascertained using validated International Classification of Diseases—Clinical Modification—9 and 10 diagnosis codes. Using Cox proportional hazard models, we studied the relationship between race and risk of ischemic stroke starting from the time of discharge from ICH hospitalization, after adjustment of demographics and vascular comorbidities. RESULTS: We included 91 342 patients with ICH—62% non-Hispanic White, 18% non-Hispanic Black, and 12% Hispanic patients. Non-Hispanic Black and Hispanic patients were younger and had a higher prevalence of cardiovascular comorbidities; however, atrial fibrillation was more prevalent among non-Hispanic White patients. During a median follow-up period of 4.4 years (interquartile range, 1.5–8.1), an incident ischemic stroke occurred in 3377 (6%) non-Hispanic White, 1323 (8%) non-Hispanic Black, and 844 (8%) Hispanic patients. In adjusted Cox models, the risk of an ischemic stroke was significantly higher among non-Hispanic Black patients (hazard ratio, 1.6 [95% CI, 1.5–1.8]) and Hispanic patients (hazard ratio, 1.4 [95% CI, 1.3–1.5]), compared with non-Hispanic White patients. Similar results were obtained in sensitivity analyses when using death as a competing risk and after excluding patients with atrial fibrillation and valvular heart disease. CONCLUSIONS: In a large heterogeneous cohort of patients with ICH, we found that non-Hispanic Black and Hispanic patients had a significantly higher risk of ischemic stroke compared with non-Hispanic White patients.

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Racial Disparities in Stroke Recurrence

Cited by 20 publications

References 49 publications

Racial and Ethnic Disparities in Neurological Care in the United States

Racial and Ethnic Disparities in Neurological Care in the United States

The Risk of a Second Stroke

Racial and Ethnic Differences in the Risk of Ischemic Stroke After Nontraumatic Intracerebral Hemorrhage

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