Racial/ethnic disparities in access to physician care and medications among US stroke survivors

Levine, Deborah A.; Neidecker, Marjorie V.; Kiefe, Catarina I.; Karve, Sudeep; Williams, Linda S.; Allison, Jeroan J.

doi:10.1212/wnl.0b013e318203e952

Cited by 61 publications

(37 citation statements)

References 38 publications

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“…46 Lower health literacy, denial of disease, concern for potential or experienced side effects of medications, absence of symptoms, burden of filling prescriptions, and perceived racial bias from the healthcare system may influence receipt of and compliance with treatment. 46 Among older stroke survivors, blacks and Mexican Americans reported poorer access to medications and physician care than whites, potentially leading to inadequate risk factor modification and recurrent events in these high-risk minority groups, 46,[50][51][52][53] although differences are attenuated after adjustment for age, sex, education, and insurance status. 51 Potential causes for these disparities include differences in socioeconomic status, healthcare access and use, and availability of community resources.…”

Section: Strokementioning

confidence: 99%

Forecasting the Future of Stroke in the United States

Ovbiagele¹,

Goldstein²,

Higashida³

et al. 2013

Stroke

678

365

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Background and Purpose-Stroke is a leading cause of disability, cognitive impairment, and death in the United States and accounts for 1.7% of national health expenditures. Because the population is aging and the risk of stroke more than doubles for each successive decade after the age of 55 years, these costs are anticipated to rise dramatically. The objective of this report was to project future annual costs of care for stroke from 2012 to 2030 and discuss potential cost reduction strategies. Methods and Results-The American Heart Association/American Stroke Association developed methodology to project the future costs of stroke-related care. Estimates excluded costs associated with other cardiovascular diseases (hypertension, coronary heart disease, and congestive heart failure). By 2030, 3.88% of the US population >18 years of age is projected to have had a stroke. Between 2012 and 2030, real (2010$) total direct annual stroke-related medical costs are expected to increase from $71.55 billion to $184.13 billion. Real indirect annual costs (attributable to lost productivity) are projected to rise from $33.65 billion to $56.54 billion over the same period. Overall, total annual costs of stroke are projected to increase to $240.67 billion by 2030, an increase of 129%. Conclusions-These projections suggest that the annual costs of stroke will increase substantially over the next 2 decades.Greater emphasis on implementing effective preventive, acute care, and rehabilitative services will have both medical and societal benefits. Key Words: AHA Scientific Statements ◼ burden of illness ◼ cost of illness ◼ early medical intervention ◼ epidemiology ◼ ethnicity ◼ healthcare reform ◼ projections and predictions ◼ race ◼ sex ◼ thrombolysis, therapeutic ◼ treatment

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Section: Strokementioning

confidence: 99%

Forecasting the Future of Stroke in the United States

Ovbiagele¹,

Goldstein²,

Higashida³

et al. 2013

Stroke

678

365

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“…198 A recent analysis of 4864 stroke survivors Ն45 years of age who responded to the National Health Interview Survey in 2000 to 2006 revealed that Mexican Americans and blacks or African Americans Ն65 years of age had reduced access to primary care providers and were less able to afford medications when compared with whites. 199 There was no difference in access to primary care providers or medications among those Ͻ65 years of age. However, Mexican Americans and blacks or African Americans in any age group had worse access to evaluation by specialists.…”

Section: Disparities In Preventionmentioning

confidence: 92%

Racial-Ethnic Disparities in Stroke Care: The American Experience

Cruz‐Flores¹,

Rabinstein²,

Biller³

et al. 2011

Stroke

422

261

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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...

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“…78 Indeed, in the National Health Interview Survey for the years 2000 through 2006, of 4864 stroke survivors >65 years of age, Mexican Americans and non-Hispanic blacks reported a lower proportion of specialist visits compared with non-Hispanic whites. 79 …”

Section: Approachabilitymentioning

confidence: 99%