Native Americans and Other Minorities Don’t Get the Same Stroke Care as Whites

Disparities between racial/ethnic minorities and whites cross all aspects of stroke care, according to an American Heart Association/American Stroke Association scientific statement published online last month in Stroke: Journal of the American Heart Association.

The statement is a comprehensive analysis of the role of race and ethnicity in stroke care and its impact on the numbers of people who have a stroke, live with its effects or die among minority groups compared to whites. It also addresses how access to care, response to treatment and participation in clinical research affects these groups.

Disparities have been found in every aspect of stroke care, from lack of awareness of stroke risk factors and symptoms to delayed arrival to the emergency room and increased waiting time.

Salvador Cruz-Flores, M.D., M.P.H., lead author of the statement and professor of neurology and director of the Souers Stroke Institute at St. Louis University in Missouri, said, “These disparities continue throughout the spectrum of the delivery of care from acute treatment to rehabilitation.”

Experts in different areas of stroke care analyzed the issue of racial and ethnic disparities in current scientific literature. The review also included Alaskan Natives, and Native Hawaiians/other Pacific Islanders.

The burden of risk factors is different among racial and ethnic groups according to the statement. For example, African-Americans have a high prevalence of hypertension, diabetes and obesity as well as other risk factors for stroke, while Hispanic-Americans have a high prevalence of metabolic syndrome, a cluster of risk factors that includes elevated waist circumference, elevated triglycerides, reduced good cholesterol, elevated blood pressure and elevated fasting glucose, and diabetes compared to whites and African-Americans.

Other factors that impact these disparities range from economic and social issues to cultural and language barriers. Attitudes, beliefs and compliance among populations differ, and the perceived or true presence of racial bias within the healthcare system can negatively impact a patient’s compliance with a healthcare provider’s advice, medications or treatment, according to the statement.

American Indians/Alaska Native adults are 60 percent more likely to have a stroke than their white adult counterparts, according to the HHS Office of Minority Health. American Indian/Alaska Native women have twice the rate of stroke than white women. Among the factors putting them at greater risk of having a stroke are obesity, high blood pressure, hypertension, high cholesterol and cigarette smoking.

The statement made several recommendations, including developing public health policies to close the gap between minorities and whites in all aspects of stroke prevention, incidence and care; more education and research to reduce disparities in stroke care; increased access to insurance coverage in minority populations; and more research on American Indians, Asian Americans and Pacific Islanders.

“It is striking that we are in the 21st century, with many advances in stroke care, yet we are still struggling to fix the differences that are present not only in the distribution of the disease but also in the level of care we provide to the different racial and ethnic groups,” Cruz-Flores said.

Read the statement at:

http://stroke.ahajournals.org/cgi/reprint/STR.0b013e3182213e24v1

 

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