Resolution of stroke care disparities depend on health system, community initiatives

LAS VEGAS — Disparities in stroke care, particularly among underrepresented populations, can be overcome through educational efforts in both the health care system and at the community level, said a presenter at BRAINWeek 2022.

“Stroke touches all lives. It has the potential to touch everyone at high risk across the population, and just because you are younger, or a woman, or a person of color, does not mean you won’t be touched by it,” Christina A. Wilson, MD, PhD, an associate professor of neurology at the University of Florida College of Medicine, said during the presentation.

Among the five persistent inequalities regarding effective stroke care, Wilson cited race and ethnicity as the most pervasive, with the most to unpack in terms of remedying issues for Black, Hispanic and Asian Americans.

Primary among them is the stroke mortality rate, which is three times higher in Black stroke patients aged 45 to 64 years, while incidence of stroke among Black and Hispanic populations is significantly higher than the incidence among white populations.

Wilson stated this is due to gaps in awareness, beginning with the stroke chain of survival — detection, dispatch, delivery, door, data, drug and disposition — which often leads to timely and proper stroke care.

She cited a survey of 72,000 individuals and their ability to recognize at least five stroke symptoms and know that dialing 911 is the appropriate response. Forty-one percent of white respondents answered correctly, while 30% of Black and 27% of Hispanic individuals answered correctly. Furthermore, the same poll revealed 61% of Black respondents were less likely to name a single vascular risk factor for stroke, and EMS utilization by patients from underrepresented groups existed at a lower rate than white individuals: 40% lower among Hispanic patients, 21% lower among Black patients and 20% lower among Asian patients.

Additional obstacles to proper stroke care Wilson noted for these specific populations were delays in time to treatment, longer ED waits, distrust of emergency medical or hospital staff and mistrust of proven treatment methods. All these factors, she said, lead to longer hospital stays, less-than-ideal poststroke care, higher risk of stroke recurrence, disparities in stroke recovery and unfavorable long-term outcomes.

Wilson offered that improvements to the patient’s external environment, such as certainty of housing, transportation, finances, exercise and proper diet, can drive more optimal outcomes with respect to stroke education and action when stroke is suspected.

“Self-efficacy leads to behavioral intent,” she added.

For its part, Wilson continued, the health care system as a whole should recognize these disparities and formulate action plans to address them, examine provider bias and improve care-level variables within the stroke treatment spectrum. At the community level, places such as barber and beauty shops can facilitate the educational process with concerted efforts aimed toward clientele.

“Despite overall improvements in stroke care, there are still deep racial and ethnic disparities,” Wilson said. “The causes and solutions for these disparities beyond traditional factors need reflection on underlying social determinants of health.”