Hmong Stroke Knowledge Survey

Hussein, Hatem; Droegemueller, Carol; Xiong, Pakou; Xiong, Zong; Dyke, Sidney Van; Mueller-Hussein, Jodi

doi:10.1353/hpu.2022.0153

Cited by 2 publications

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“…We conducted a stroke health literacy survey within the Hmong community and found that 95% of respondents could name at least 1 correct stroke symptom, yet only 78% indicated that the first action they would take in the case of a stroke would be to call 911. 44 The reason for this discrepancy is unknown. Importantly, for Hmong patients with ICH, arrival at the ED was not delayed compared with White patients.…”

Section: Discussionmentioning

confidence: 99%

Stroke Characteristics in a Cohort of Hmong American Patients

Hussein

Kashyap

O'Keefe

et al. 2023

JAHA

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Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P <0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P <0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P =0.03496), worse lipid profile, higher hemoglobin A 1C , similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small‐vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P <0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P =0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.

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Section: Discussionmentioning

confidence: 99%

Stroke Characteristics in a Cohort of Hmong American Patients

Hussein

Kashyap

O'Keefe

et al. 2023

JAHA

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“…The low rate of EMS utilization in non-white patients with AIS and TIA and the significant delay in arrival is similar to the observed delay in Hmong Americans [20] and racial minorities in general [31,32]. We recently conducted a stroke health literacy survey within the Hmong community and found that while 95% of respondents could name at least one correct stroke symptom, only 78% indicated that the first action they would take in the case of a stroke would be to call 911, while other respondents indicated that they would call an elder, call their doctor, drink water, take an aspirin, call 911 only if symptoms are severe, and other behaviors that are not helpful in the case of a stroke emergency [33]. We also learned from that survey that there is no equivalent word for 'stroke' in the Hmong language despite the familiarity of the respondents with stroke symptoms, and the anecdotal reports from Hmong community leaders indicate that many deaths in the Minnesota Hmong community were related to stroke [34].…”

Section: Discussionmentioning

confidence: 99%

Racial Impact on Inpatient Stroke Quality of Care in Two Community Hospitals

Hussein,

Yang,

Ramezani

et al. 2023

JCM

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Introduction: This analysis was conducted as a part of a quality improvement project aiming at identifying racial disparity in inpatient stroke quality of care. Methods: The Get With The Guidelines (GWTG) database was used to identify all patients discharged with any stroke diagnosis between January and December 2021. An additional chart review was conducted to ensure the accuracy of racial/ethnic categorization. The sample was dichotomized into white vs. non-white groups and compared with univariate analysis. Results: The study sample comprised 1408 encounters (1347 patients) with Mean age of 71 ± 15 years, 51% women, 82% white patients, 15% non-white patients, 72% acute ischemic stroke (AIS); 15% transient ischemic attack (TIA), 9% intracerebral hemorrhage (ICH), 3% subarachnoid hemorrhage (SAH), and 1% stroke not otherwise specified. Non-white patients were younger and had fewer concomitant diagnoses, a lower proportion of TIA, and a higher proportion of ICH (p = 0.004). In the AIS cohort, compared to white patients, non-white patients had less frequent ambulance (p = 0.009), arrived at the hospital later than white patients (7.7 h longer; p < 0.001), had more severe strokes, and had less frequent IV thrombolysis utilization (7% vs. 13%; p = 0.042). Similarly, in the TIA cohort, non-white patients’ utilization of EMS was lower than that of white patients, and their hospital arrival was delayed. In the ICH cohort, non-white patients were younger and had a lower frequency of atrial fibrillation and a non-significant trend toward higher disease severity. The SAH cohort had only eight non-white patients, six of whom were transferred to a higher level of hospital care within a few hours of arrival. Importantly, the hospital-based quality metrics, such as door-to-CT time, door-to-needle time, and the Joint Commission stroke quality metrics, were similar between the two groups. Conclusions: There is a racial disparity in the pre-hospital phase of the stroke chain of survival of non-white patients, impacting IV thrombolysis utilization. The younger age and worse lipid profile and hemoglobin A1c of non-white patients suggest the need for better preventative care starting at a young age.

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Hmong Stroke Knowledge Survey

Cited by 2 publications

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Stroke Characteristics in a Cohort of Hmong American Patients

Stroke Characteristics in a Cohort of Hmong American Patients

Racial Impact on Inpatient Stroke Quality of Care in Two Community Hospitals

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