Racial-Ethnic Disparities in Stroke Care: The American Experience

Abstract

Purpose-Our goal is to describe the effect of race and ethnicity on stroke epidemiology, personal beliefs, access to care, response to treatment, and participation in clinical research. In addition, we seek to determine the state of knowledge on the main factors that may explain disparities in stroke care, with the goal of identifying gaps in knowledge to guide future research. The intended audience includes physicians, nurses, other healthcare professionals, and policy makers. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council Scientific Statement Oversight Committee and represent different areas of expertise in relation to racial-ethnic disparities in stroke care. The writing group reviewed the relevant literature, with an emphasis on reports published since 1972. The statement was approved by the writing group; the statement underwent peer review, then was approved by the American Heart Association Science Advisory and Coordinating Committee. Results-There are limitations in the definitions of racial and ethnic categories currently in use. For the purpose of this statement, we used the racial categories defined by the US federal government: white, black or African American, Asian, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander. There are 2 ethnic categories: people of Hispanic/Latino origin or not of Hispanic/Latino origin. There are differences in the distribution of the burden of risk factors, stroke incidence and prevalence, and stroke mortality among different racial and ethnic groups. In addition, there are disparities in stroke care between minority groups compared with whites. These disparities include lack of awareness of stroke symptoms and signs and lack of knowledge about the need for urgent treatment and the causal role of risk factors. There are also differences in attitudes, beliefs, and compliance among minorities compared with whites. Differences in socioeconomic status and insurance coverage, mistrust of the healthcare system, the relatively limitedThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on April 6, 2011. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@woltersklu...

Professional Medical Interpreters Influence the Quality of Acute Ischemic Stroke Care for Patients Who Speak Languages Other than English

“…GWTG‐Stroke, when linked to administrative data, provides a unique opportunity to systematically characterize patients’ linguistic needs, understand how they are met, and identify their influence on patients’ care and outcomes. Second, our study results expand our knowledge of racial and socioeconomic factors associated with stroke care disparities, reinforcing that we need to better understand and address the social determinants of stroke care and outcomes 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51. The Office of Minority Health provides a framework for healthcare systems to meet patient linguistic needs through the National Standards for Culturally and Linguistically Appropriate Services in Health Care 52.…”

Collaborative Interventions Reduce Time-to-Thrombolysis for Acute Ischemic Stroke in a Public Safety Net Hospital

“…These patients have less access to healthcare and are less likely to receive tPA, despite having more frequent and more severe strokes. [19][20][21][22][23][24] We present our implementation of 11 multidisciplinary, collaborative, targeted interventions to reduce DTN time in a large, urban, public safety net hospital. We analyzed DTN times before and after each intervention with the goal of understanding the combined and individual effects of our interventions on DTN time.…”

Racial‐Ethnic Disparities in Acute Stroke Care in the Florida‐Puerto Rico Collaboration to Reduce Stroke Disparities Study

“…The AHA/ASA summarized the importance of racial‐ethnic disparities in stroke care 3. Our study fills an important gap in stroke research, as the AHA/ASA emphasized the need for more statewide or regional stroke registries that track stroke care data and statistics on quality performance metrics.…”

“…Racial‐ethnic disparities in acute stroke care have been documented in a statement from the American Heart Association/American Stroke Association (AHA/ASA),3 and represent a recognized research priority by the National Institute of Neurological Disorders and Stroke (NINDS). These disparities can contribute to inequality in outcomes after acute stroke.…”

“…Incidence data from NOMAS (the Northern Manhattan Study) has demonstrated racial‐ethnic differences in stroke incidence, with blacks and Hispanics having more than a 2‐fold increase in annual stroke incidence compared with whites 4, 5. Some studies have documented disparities in access to acute stroke care, activation of 911 services, delayed arrival to the emergency department, longer waiting times, and treatment delays in thrombolysis 3. The aging and rapid growth of the Hispanic population and growing socioeconomic crisis in Puerto Rico (PR) may increase the public health impact of stroke and widen stroke disparities.…”