Mexican Americans Receive Less Intensive Stroke Rehabilitation Than Non-Hispanic Whites

Abstract

Background and Purpose Mexican Americans (MAs) have worse neurologic, functional and cognitive outcomes after stroke. Stroke rehabilitation is important for good outcome. In a population-based study, we sought to determine if allocation of stroke rehabilitation services differed by ethnicity. Methods Stroke patients were identified as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project, Texas, USA. Cases were validated by physicians using source documentation. Patients were followed prospectively for three months following stroke to determine rehabilitation services and transitions. Descriptive statistics were used to depict the study population. Continuous baseline variables were compared using two sample t-tests or Wilcoxon rank-sum tests by ethnicity. Categorical baseline variables were compared using chi-squared tests. Ethnic comparisons of rehabilitation services were compared using chi-squared tests, Fisher’s exact tests and logistic regression. Results Seventy-two subjects (50 MA and 22 non-Hispanic white [NHW]) were followed. Mean age, NHW-69 (sd-13), MA-66 (sd-11) years, sex (NHW 55% male, MA 50% male) and median presenting NIHSS did not differ significantly. There were no ethnic differences among the proportion of patients who were sent home without any rehabilitation services (p=0.9). Among those who received rehabilitation NHWs were more likely to get inpatient rehabilitation (73%) compared with MAs (30%), p=0.016. MAs (51%) were much more likely to receive home rehabilitation services compared with NHWs (0%) (p=0.0017). Conclusions In this population-based study, MAs were more likely to receive home-based rehabilitation while NHWs more likely to get inpatient rehabilitation. This disparity may, in part, explain the worse stroke outcome in MAs.

Multiple Chronic Conditions and Functional Outcome after Ischemic Stroke: A Systematic Review and Meta-Analysis

“…To date, none of the currently used MCC indices were developed in population-based studies, which reflect the full spectrum of chronic conditions in the stroke population. Some indices were developed only in rehabilitation patients, which represent less than one-third of the total stroke population [13]. Because patients with more severe comorbid conditions are often excluded from rehabilitation, patients from inpatient rehabilitation have a different distribution and level of severity in comorbid conditions compared to the majority of stroke patients [35,37].…”

“…FO in nonthrombolyzed stroke survivors has been largely unchanged [12]. Similarly, acute inpatient rehabilitation, which reduces longterm disability and enhances FO, is received by only a minority of stroke patients after the acute hospitalization [13].…”

The Impact of Pre-Stroke Depressive Symptoms, Fatalism, and Social Support on Disability after Stroke

“…For example, familism is a recognized cultural value that can affect beliefs around care for the elderly in Mexican Americans families (34). We have previously shown that Mexican Americans from this population are more likely than White Americans to go home with home therapy rather than to more intensive inpatient rehabilitation after an acute stroke (35). One possible explanation for this finding is that certain Mexican American families may have the support system and preference to care for their family member at home despite the recommendation for inpatient rehabilitation.…”

The difficulty of studying race-ethnic stroke rehabilitation disparities in a community

“…Race-ethnic disparities in stroke outcomes have been documented 2 . One possible but little studied contributor to these disparities is race-ethnic differences in access to post-stroke rehabilitation or in the utilization and/or effectiveness of rehabilitation 3 . Remarkably, little published data exist on race-ethnic disparities in stroke rehabilitation from any study design or data source.…”

“…First, only a small proportion of stroke patients receive rehabilitation in the inpatient setting 7 . Second, there are race-ethnic differences in the utilization of inpatient rehabilitation, with minorities less likely to receive rehabilitation in this setting, which could be the result of structural barriers, such as insurance coverage, patient and family preferences, or other factors 3 . Therefore, the inpatient rehabilitation population is highly select and does not reflect the broader stroke population and disproportionately excludes minorities.…”