- A recent study found that Black and Hispanic U.S. veterans have a higher risk of dying in the first month after certain stroke types than white veterans.
- Researchers looked at the medical records of over 37,000 veterans.
- Stroke is one of the leading causes of death for Americans.
Black and Hispanic U.S. veterans are more likely to die in the first 30 days after certain types of stroke compared to white veterans, a new study found.
However, these groups have lower mortality rates than whites after other types of stroke and at different periods after a stroke.
The study, published June 1 in Neurology, the American Academy of Neurology medical journal, provides updated estimates of mortality rates after a stroke for veterans.
It also adds additional information about mortality rates after different types of stroke and among racial and ethnic groups.
“Research on stroke patients has shown disparities in stroke outcomes for people of color for decades,” said Dr. Erica Jones, an assistant professor of neurology at UT Southwestern Medical Center in Dallas, who was not involved in the new research.
“The results of this [new study] point out that a one-size-fits-all approach cannot be taken in discussions of prognostication,” she added. “There are many variables to be considered in predicting how patients will recover and survive after strokes, with race being among them.”
Jones’s research has shown a decreased likelihood of good functional recovery after stroke in the Black and Latino population.
For the study, researchers reviewed the health records of more than 37,000 veterans admitted because of a stroke to a Veterans Health Administration hospital between 2002 and 2012.
Researchers also gathered information about patients’ race and ethnicity, the type of stroke that they had, and which patients died during the study period.
They also considered other factors that could affect the risk of death after a stroke, such as age, sex, smoking, diabetes, and heart disease.
The majority of strokes (89 percent) experienced by patients were ischemic, which are caused by a blood clot. The rest were caused by bleeding in the brain, also known as hemorrhagic stroke; there were two types of these reported.
Black patients had a 3 percent higher risk of dying within the first 30 days after an intracerebral hemorrhage stroke compared to white patients, researchers found.
This higher risk for Black people occurred mainly within the first 20 days after the stroke.
In addition, Hispanic patients had a 10 percent higher risk of dying within the first 30 days after a subarachnoid hemorrhage stroke than white patients.
However, Black and Hispanic patients had lower mortality rates compared to white patients after an acute ischemic stroke for certain time periods.
However, the study has several limitations that need to be addressed by future research.
One is that nearly all patients were male, so the results may not apply to women. In addition, researchers could not take into account the severity of the stroke, which can affect a person’s risk of dying.
Researchers also had to exclude Native American, Alaska Native, Native Hawaiian, and Asian American veterans from their analysis due to a low number of patients from these groups.
Stroke is a
In addition, Black Americans are almost two times more likely to have a first stroke compared to whites, reports the CDC. Black people also have the highest rate of death due to stroke.
Hispanics have also seen an increase in 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 breakdown of mortality by stroke type and race/ethnicity, and the fact that researchers followed patients for over a year after their stroke.
“Longer follow-up periods in this study may permit clinicians to provide patients and families with a better understanding of the likelihood of surviving to their next significant life event,” they wrote.
However, Albright and Howard said one key question that needs to be addressed is how the results of this study can help health providers discuss with patients and families their chances of recovery after a stroke over the short- and long-term.
Although the new study provides greater insight into stroke outcomes for different groups, Jones said the results raise more questions than they provide answers.
“The fact that some groups consistently do worse than others should raise alarms that there are systemic issues driving these differences,” she said.
“We, as a healthcare community, have 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, program director of Tulane University’s online Master of Health Administration program and an 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 disparities related to stroke and other health outcomes.
“Studies have shown consistent inverse and stepwise relationships between class and premature death for minorities,” said Campbell. “In addition, there are wide differences in health outcomes between those who have resources and those who do not.”
The authors of the new paper called for additional research, including on stroke mortality 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 the factors that contribute to racial/ethnic differences in stroke outcomes, including social and economic factors that impact health.
Also known as social determinants of health, these factors include access to good education, good-paying jobs, healthy food, and healthcare.
While studies like the new one provide a greater understanding of health disparities faced by certain groups, research also needs to move beyond that to find solutions that work for all communities.
“A shift is needed away from just describing these disparities in stroke outcomes toward development of effective interventions to prevent disparities,” said Jones.
This should include clinicians and researchers partnering with patients and Black and Latino communities to come up with ways to close the gaps in stroke care, she added.
Although stroke-related health disparities will not be fixed quickly, Jones is encouraged by improvements that have already occurred in some areas.
To make this happen, “the healthcare community needs to invest in making changes to 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, “healthcare organizations’ executive leadership must work to reduce barriers for all and create the internal infrastructure needed to create more equitable access,” he said.
In addition, these organizations need to “help patients deal with the social determinants of health, and reduce structural racism and racist policies that are rooted in U.S. healthcare industry,” he said.