Stroke Disparities: From Observations to Actions: Inaugural Edward J. Kenton Lecture 2020

Abstract

Numerous epidemiological studies have demonstrated stroke disparities across race and ethnic groups. The goal of the NOMAS (Northern Manhattan Study) was to evaluate race and ethnic differences in stroke within a community with 3 different race-ethnic groups. Starting as a population-based incidence and case-control study, the study evolved into a cohort study. Results from NOMAS have demonstrated differences in stroke incidence, subtypes, risk factors, and outcomes. Disparities in ideal cardiovascular health can help explain many differences in stroke incidence and call for tailored risk factor modification through innovative portals to shift more diverse subjects to ideal cardiovascular health. The results of NOMAS and multiple other studies have provided foundational data to support interventions. Conceptual models to address health disparities have called for moving from detecting disparities in disease incidence, to determining the underlying causes of disparities and developing interventions, and then to testing interventions in human populations. Further actions to address race and ethnic stroke disparities are needed including innovative risk factor interventions, stroke awareness campaigns, quality improvement programs, workforce diversification, and accelerating policy changes.

Keywords: epidemiology; health equity; incidence; quality improvement; risk factors.

Figure 1:

Northern Manhattan Study Timeline

Figure 2:

Age-adjusted stroke incidence rates per 1000 person-years for white, Black and Hispanic men and women in the Northern Manhattan Study stratified by age 70.

Figure 3:

Florida Stroke Registry Hospitals 2019. Pin drops represent the locations of the 121 FSR participating hospitals. The various pin drop colors represent the FSR hospital’s stroke certification type. (Comprehensive Stroke Certification, Thrombectomy Stroke Capable, Primary Stroke Certification, Acute Stroke Ready, Not currently certified)

Figure 4:

Conceptual framework of the Florida Stroke Registry based on socio-ecological model of the spheres of influence.

Figure 5:

Annual Hospital Disparities Dashboards demonstrates overall stroke performance and by race-ethnic group benchmarked to region and state.

Figure 6:

Temporal trends in IV rt-PA utilization within 4.5 hours among eligible patients arriving within 3.5 hours from 2010 to 2018 across race and ethnic subgroups showing that non-Hispanic Blacks were less likely to receive treatment compared to non-Hispanic Whites.