Racial Disparity Amongst Stroke Patients During the Coronavirus Disease 2019 Pandemic

Abstract

The global coronavirus disease 2019 (COVID-19) pandemic has had deleterious effects on our healthcare system. Lockdown measures have decreased the number of patients presenting to the hospital for non-respiratory illnesses, such as strokes. Moreover, there appears to be a racial disparity among those afflicted with the virus. We sought to assess whether this disparity also existed for patients presenting with strokes. Methods The Get with the Guidelines National Stroke Database was reviewed to assess patients presenting with a final diagnosis of ischemic stroke, transient ischemic attack (TIA), subarachnoid hemorrhage (SAH), or spontaneous/nontraumatic intraparenchymal hemorrhage (IPH). The period of February-May 2020 was chosen given the surge of patients affected with the virus and national shutdowns. Data from this same time during 2019 was used as the control population. Our hospital numbers and four additional regions were assessed (California hospitals, Pacific State hospitals, Western Region hospitals, and all hospitals in the United States). Patients were categorized by race (White, Black/African American, Asian, Native American, Hispanic) in each cohort. The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting with stroke during the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results A downward trend in total number of patients was noted in all five regional cohorts assessed. A statistically significant increase in the number of Black and Hispanic patients presenting with strokes was noted in California, Pacific hospitals, Western hospitals, and all hospitals in the United States during various months studied comparing 2020 to 2019. A statistically significant increase in the Hispanic population was noted in February and March in all California hospitals (p=0.005 and 0.02, respectively) and Pacific Coast hospitals (p=0.005 and 0.039, respectively). The Western region and all national hospitals noted a significant increase in strokes in the Hispanic population in April (p=0.039 and 0.023, respectively). A statistically significant increase of strokes in the Black population was noted in April in Pacific hospitals,

Stroke Severity in Ischemic Stroke Patients with a History of Diastolic Blood Pressure Treated in a Telestroke Network

“…In general, African Americans, Hispanics, and Native Americans have higher stroke risks, stroke occurrence at an earlier age, and for some minorities, possibly more severe strokes than non-Hispanic whites [ 74 ]. Our finding of reduced stroke severity in Caucasian AIS patients with DBP > 80 mmHg is supported by studies indicating that a higher prevalence of risk factors [ 75 ], lower socioeconomic status [ 76 ], and health care system challenges for minority patients [ 77 ] may contribute to higher stroke severity when compared with Caucasian AIS patients. Our results lend further credence to the suggestions that breaking down barriers to care is an important step to take critical steps toward reducing stroke disparities.…”

Decrease in Stroke Diagnoses During the COVID-19 Pandemic: Where Did All Our Stroke Patients Go?

“…The avoidance of primary care for chronic disease management can subsequently manifest in an increase in emergent hospitalization for stroke. A statistically significant increase in the proportion of Black and Hispanic patients presenting with strokes was noted in California, Pacific hospitals, Western hospitals, and all hospitals in the United States during various months studied, comparing 2020 to 2019 [ 79 ]. It is not clear what proportion of patients with severe strokes are foregoing medical care or are otherwise underdiagnosed.…”