Interventions needed to address stroke inequities for Black, Hispanic, Indigenous people
Click Here to Manage Email Alerts
Key takeaways:
- Data show there are large racial and ethnic disparities in stroke outcomes.
- Despite research highlighting the issue, there is still a need for well-designed studies and effective interventions.
Significant racial and ethnic inequities persist in all aspects of stroke care, yet interventions that adequately address social determinants of health and other related factors are lacking, according to a new scientific statement.
“There are enormous inequities in stroke care, which lead to significant gaps in functional outcomes after stroke for people from historically disenfranchised racial and ethnic groups, including Black, Hispanic and Indigenous peoples,” Amytis Towfighi, MD, FAHA, associate professor of neurology (clinical scholar) at Keck School of Medicine of the University of Southern California, director of neurological services and innovation for Los Angeles County Department of Health Services and associate chief medical officer and chair of the neurology department at Rancho Los Amigos National Rehabilitation Center in Downey, California, said in a press release. “While research has historically focused on describing these inequities, it is critical to develop and test interventions and address them.”
Image: Adobe Stock
In the statement, Towfighi and colleagues summarized trials of interventions addressing racial and ethnic inequities in stroke care and outcomes and conducted a literature review to identify gaps and areas for future research. The researchers noted that some studies assessed interventions aimed at reducing inequities in prehospital, acute care, transitions in care and poststroke risk factor control; however, few addressed inequities in rehabilitation, recovery and social reintegration. Most studies, they noted, addressed medication adherence, health literacy and health behaviors, without addressing social determinants of health.
“Historically disenfranchised populations are vastly underrepresented in clinical stroke trials, limiting our understanding of inequities, reducing the generalizability of findings and exacerbating inequities,” the researchers wrote. “Most trials do not have systems in place to ensure retention of historically disenfranchised populations in clinical trials, and rarely do they evaluate implementation to determine if there is differential implementation of protocols by patient subpopulation. To address health inequities, it is critical to ensure equitable participation in research and to develop and implement best practices to ensure engagement and retention.”
The researchers also noted that several stroke studies did not reach their primary prespecified endpoints but showed improvements in key secondary endpoints, such as control of other vascular risk factors, self-management and patient experience. Rejecting such studies as “failures” could be a disservice to the field, they wrote.
“Whenever possible, equity should be considered as an a priori endpoint,” the researchers wrote.
In addition to risk-based interventions, population-based interventions on a wider scale could also impact stroke inequities. These include use of a polypill to reduce CV inequities, food regulations around salt and sugar, environmental-level interventions to address access to nutritious affordable food, neighborhood-level interventions to address safety, and physical activity.
“Health care professionals need to think outside the ‘stroke box’; sustainable, effective interventions to address inequities will likely require collaboration with patients, their communities, policymakers and other sectors,” Towfighi said in the release.
Reference:
- Wide-ranging strategies needed to eliminate racial and ethnic inequities in stroke care. https://newsroom.heart.org/news/wide-ranging-strategies-needed-to-eliminate-racial-and-ethnic-inequities-in-stroke-care. Published on May 15, 2023. Accessed on May 15, 2023.
Collapse
Read more about
Click Here to Manage Email Alerts