Neurologists Address Disparities In Stroke Care

ST. LOUIS – Significant disparities in stroke treatment and prevention exist for racial and ethnic minorities, writes Dr. Salvador Cruz-Flores for Stroke: Journal of the American Heart Association.  Dr. Cruz-Flores adds, "Awareness, education and prevention are the keys to closing this health care gap."

Cruz-Flores, professor of neurology and director of the Souers Stroke Institute at Saint Louis University says, “We see disparities in every aspect of stroke care, from lack of awareness of stroke risk factors and symptoms to delayed arrival to the emergency room and increased waiting time.”

In terms of emergency care, minorities use emergency services less, are delayed in arriving at the emergency room, have longer waiting times once they arrive, and are less likely to receive clot-busting medication for stroke.

Beyond emergency situations, disparities appear in every aspect of the stroke care spectrum, from prevention to rehabilitation, with wide-ranging biological, environmental, economic and cultural origins.

“In some cases, the disparity is based on a biological factor,” said Cruz-Flores. “For reasons we don’t fully understand, some racial and ethnic minorities have a higher predisposition to some health problems. African Americans have a greater burden of high blood pressure. Hispanic Americans have greater burden of diabetes and metabolic syndrome.

“By treating high blood pressure, diabetes and high cholesterol, we can really lower the risk of stroke.”

Other factors include differences in socioeconomic status, insurance coverage, cultural differences and language barriers.

“Racial minorities often feel more comfortable with health care providers who are also racial minorities, but we don’t have enough doctors to meet that need,” said Cruz-Flores. “In addition, to combat the possibility of bias, we need doctors who are culturally competent.”

Finally, it’s important for health care providers to understand why their patients may not comply with their doctor’s advice when it comes to prevention.

“I can recommend a change of behavior, but when people live in dangerous neighborhoods or far from a park, it’s hard to tell them to get exercise,” said Cruz-Flores. “Even if a patient manages to see a doctor, will he or she have the money to pay for medication?

“These are realities we need to address because stroke and cardiovascular disease are both treatable and preventable.”

The American Heart Association statement calls for more education for health care providers and patients, more research, better insurance coverage for minorities and the development of public health policies to close the gap in all aspects of stroke prevention, incidence and care.

“We must do better,” said Cruz-Flores. “We must recognize that this group of obstacles is having real effects on the health of many Americans.”