- A recent study found that black and Hispanic American veterans have a higher risk of dying within the first month after certain types of stroke than white veterans.
- The researchers examined the medical records of more than 37,000 veterans.
- Stroke is one of the leading causes of death among Americans.
According to a new study, black and Hispanic American veterans are more likely to die within the first 30 days after certain types of stroke than white veterans.
However, these groups have lower mortality rates than whites after other types of stroke and at different time periods after stroke.
The study, published June 1 in Neurology, the medical journal of the American Academy of Neurology, provides updated estimates of death rates after stroke among veterans.
It also adds additional information on mortality rates after different types of stroke and among racial and ethnic groups.
“Stroke patient research has shown disparities in stroke outcomes for people of color for decades,” said Dr. Erica Jones, assistant professor of neurology at UT Southwestern Medical Center in Dallas. , who did not participate in the new research.
“The results of this [new study] emphasize that a one-size-fits-all approach cannot be taken in prognosis discussions,” she added. “There are many variables to consider in predicting how patients will recover and survive after stroke, race being one of them.”
Jones’ research has shown a decreased likelihood of good functional recovery after stroke in black and Latino populations.
For the study, researchers reviewed the medical records of more than 37,000 veterans admitted with stroke to a Veterans Health Administration hospital between 2002 and 2012.
The researchers also collected information on the race and ethnicity of the patients, the type of stroke they suffered, and the patients who died during the study period.
They also took into account other factors that may affect the risk of death from stroke, such as age, gender, smoking, diabetes and heart disease.
The majority of strokes (89%) suffered by patients were ischemic, caused by a blood clot. The others were caused by bleeding in the brain, also known as a hemorrhagic stroke; there were two types reported.
Black patients had a 3% higher risk of dying within the first 30 days after a stroke with intracerebral hemorrhage compared to white patients, the researchers found.
This higher risk for blacks occurred primarily in the first 20 days after stroke.
Additionally, Hispanic patients had a 10% higher risk of dying within the first 30 days after stroke with subarachnoid hemorrhage than white patients.
However, black and Hispanic patients had lower mortality rates than white patients after acute ischemic stroke during certain time periods.
However, the study has several limitations that need to be addressed by future research.
The first is that almost all of the patients were male, so the results may not apply to women. Additionally, the researchers could not take into account the severity of the stroke, which can affect a person’s risk of death.
The researchers also had to exclude Native American, Alaska Native, Hawaiian, and Asian American veterans from their analysis due to the small number of patients in these groups.
Stroke is a
Additionally, black Americans are nearly twice as likely to have a first stroke as whites, the CDC reports. Blacks also have the highest rate of death from stroke.
Hispanics have also seen rising stroke death rates over the past decade, the agency said.
In an accompanying editorial, Dr. Karen C. Albright and Virginia J. Howard, PhD, said the new study “does much to improve our understanding of racial and ethnic differences in stroke mortality among veterans.” .
They point to several strengths of the paper, including the large number of patients included in the study, the distribution of mortality by type of stroke and race/ethnicity, and the fact that the researchers followed the patients for more than a year after their stroke.
“Longer follow-up periods in this study may allow clinicians to provide patients and families with a better understanding of the likelihood of surviving their next significant life event,” they wrote.
However, Albright and Howard said a key question that needs to be addressed is how the results of this study can help healthcare providers talk with patients and families about their chances of recovery after a short-term stroke. long-term.
Although the new study provides better insight into stroke outcomes for different groups, Jones said the results raise more questions than they answer.
“The fact that some groups consistently do worse than others should ring alarm bells that systemic issues are driving these differences,” she said.
“We, as the health community, need to ask ourselves how we contribute to creating these disparities and what role do we have in correcting them,” she added.
Kenneth Campbell, DBE, MPH, director of Tulane University’s online master’s in health administration program and assistant professor in the School of Public Health and Tropical Medicine, said the new study shows that more work needs to be done to reduce stroke-related disparities. and other health effects.
“Studies have shown consistent inverse and progressive relationships between class and early death for minorities,” Campbell said. “Furthermore, there are large differences in health outcomes between those with resources and those without.”
The authors of the new paper called for further research, including on stroke death rates among other racial and ethnic groups, as well as how often life-sustaining therapies after stroke are used. among different groups.
Jones said research is also needed to identify factors that contribute to racial/ethnic differences in stroke outcomes, including social and economic factors that impact health.
Also known as the social determinants of health, these factors include access to a good education, well-paying jobs, healthy food, and health care.
While studies like the novel provide insight into the health disparities faced by certain groups, research must also go beyond to find solutions that work for all communities.
“There is a need to move from simply describing these disparities in stroke outcomes to developing effective interventions to prevent the disparities,” Jones said.
This should include clinicians and researchers partnering with Black and Latino patients and communities to find ways to fill gaps in stroke care, she added.
While stroke-related health disparities aren’t being fixed quickly, Jones is encouraged by the improvements that have already occurred in some areas.
To achieve this, “the health care community must invest in changes in the way care is delivered to these populations now to prevent disparities from negatively impacting more people in the future.” , she said.
Campbell agrees, saying “the executive leadership of healthcare organizations must work to reduce barriers for everyone and create the internal infrastructure necessary to create more equitable access,” he said.
In addition, these organizations must “help patients manage the social determinants of health and reduce structural racism and racist policies embedded in the American healthcare industry,” he said.