Interventions Targeting Racial/Ethnic Disparities in Stroke Prevention and Treatment

Abstract

Systemic racism is a public health crisis. Systemic racism and racial/ethnic injustice produce racial/ethnic disparities in health care and health. Substantial racial/ethnic disparities in stroke care and health exist and result predominantly from unequal treatment. This special report aims to summarize selected interventions to reduce racial/ethnic disparities in stroke prevention and treatment. It reviews the social determinants of health and the determinants of racial/ethnic disparities in care. It provides a focused summary of selected interventions aimed at reducing stroke risk factors, increasing awareness of stroke symptoms, and improving access to care for stroke because these interventions hold the promise of reducing racial/ethnic disparities in stroke death rates. It also discusses knowledge gaps and future directions.

Impact of Intravenous Alteplase Door-to-Needle Times on 2-Year Mortality in Patients With Acute Ischemic Stroke

“…Moreover, there was no statistically significant interaction between DTN and sociodemographic characteristics on the 30-day, 1-year, or 2-year mortality, indicating that all socio-demographic groups benefited equally from faster DTN times. The findings of our study further reinforce the need to implement specific interventions to reduce racial/ethnic disparities, improve stroke awareness and access to stroke healthcare among racial minorities ( 27 ).…”

Stroke hospitalizations, posttraumatic stress disorder, and 9/11‐related dust exposure: Results from the World Trade Center Health Registry

“…It should be noted that the observed stroke disparities by race/ethnicity are likely to be attributed to racial-ethnic minority groups such as non-Hispanic Blacks' limited access to quality care and lower socioeconomic status, which resulted in their higher prevalence and worse control of traditional vascular risk factors. [43][44][45] Using stroke cases from hospitalization data, this study took a step forward in identifying the association between 9/11-related PTSD, dust exposure, and stroke subtype as compared with our first study, which used self-reported stroke. However, the results should still be interpreted with caution as there are several limitations to note.…”

“…When we compared the significance and magnitude of PTSD impact on stroke, it was clear that PTSD played an even larger role than sex (male) and race (non‐Hispanic Black) in this population. It should be noted that the observed stroke disparities by race/ethnicity are likely to be attributed to racial‐ethnic minority groups such as non‐Hispanic Blacks' limited access to quality care and lower socioeconomic status, which resulted in their higher prevalence and worse control of traditional vascular risk factors 43–45 …”

Striving for Socioeconomic Equity in Ischemic Stroke Care: Imaging and Acute Treatment Utilization From a Comprehensive Stroke Center

“…When assessing health care disparities, it is important to consider patient-, neighborhood-, and health system-level factors affecting the access, availability, and utilization of health care resources. Patients with demographic characteristics subject to traditional disparities-Black race, female sex, older age, Medicaid insurance type, and lower income level-have historically experienced greater stroke morbidity and mortality than their more advantaged counterparts [2,3,[11][12][13][14][15][16][17][18][19][20][21]. Although imaging and treatment of patients with stroke are performed according to guidelines, care variability and implicit biases exist, and prior research has demonstrated that imaging and treatment are not utilized equally across different populations.…”