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[Preprint]. 2025 Jan 7:2025.01.06.25320085.
doi: 10.1101/2025.01.06.25320085.

Race and ethnic disparities in rehabilitation services and functional recovery post-stroke

Lauri Bishop  1 , Hannah Gardener  2 , Scott C Brown  3 , Emir Veledar  2 , Karlon H Johnson  4 , Erika T Marulanda-Londono  2 , Carolina M Gutierrez  2 , Neva Kirk-Sanchez  1 , Jose Romano  2 , Tatjana Rundek  2
Affiliations

Race and ethnic disparities in rehabilitation services and functional recovery post-stroke

Lauri Bishop et al. medRxiv. .

Update in

Abstract

Objective: To identify race/ethnic disparities in rehabilitation services after stroke and characterize the independent associations of each of race/ethnicity and rehabilitation to functional recovery post-stroke.

Methods: The Transitions of Care Stroke Disparities Study (TCSD-S) is a prospective cohort study designed to reduce disparities and to optimize the transitions of care for stroke survivors throughout the state of Florida. Participant characteristics were extracted from the American Heart Association's Get-With-The-Guidelines-Stroke dataset. Rehabilitation services, and modified Rankin Scale were recorded via follow up phone calls at 30- and 90-days after hospital discharge. Logistic regression models adjusted for potential confounders were used to determine: 1) race/ethnic differences in rehabilitation services received; 2) race/ethnic differences in functional change from discharge to 30- and 90-days, respectively; and 3) the influence of rehabilitation on functional change from discharge to 30- and 90-days.

Results: Of 1,083 individuals, 43% were female, 52% were Non-Hispanic White (NHW), 22% were Non-Hispanic Black (NHB), and were 22% Hispanic. Individuals who engaged in rehabilitation were more likely to show improvements [aOR=1.820, 95%CI (1.301,2.545)] at 90-days from hospital discharge. Irrespective of rehabilitation services, there were no differences in functional change between NHW and NHB individuals, yet Hispanic individuals were less likely to improve [aOR=0.647, 95%CI (0.425,0.983)] compared to NHW. Additionally, Hispanic individuals were significantly less likely to receive any rehabilitation services [aOR=0.626, 95%CI (0.442,0.886)] and were half as likely to receive outpatient services [aOR=0.543, 95%CI (0.368,0.800)] as compared to NHW.

Conclusions: Rehabilitation is key to functional improvement after stroke. We are making strides in health equity between NHW and NHB individuals, yet there remain disparities in functional outcomes and in rehabilitation services particularly for Hispanic individuals after stroke.

Keywords: Stroke; functional outcomes; recovery; rehabilitation.

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Conflict of interest statement

Disclosures: There are no disclosures in addition to the funding sources identified above.

Figures

Figure 1:
Figure 1:. Participant flow diagram.
Figures 2A and B:
Figures 2A and B:. Race/ethnic differences in (A) receipt of rehabilitation services or not receiving any rehabilitation services and (B) type of rehabilitation services received.
Figures 3A and 3B:
Figures 3A and 3B:. Race/ethnic differences in functional change at A.30- and B. 90- days after hospital discharge.
Figures 4A and B:
Figures 4A and B:. The association between rehabilitation services and functional change at A.30- and B. 90-days after hospital discharge.
See this image and copyright information in PMC

References

    1. Willey JZ, Moon YP, Sacco RL, et al. Physical inactivity is a strong risk factor for stroke in the oldest old: findings from a multi-ethnic population (the Northern Manhattan Study). Int J Stroke. 2017;12(2):197–200. doi: 10.1177/1747493016676614 - DOI - PMC - PubMed
    1. Bell EJ, Lutsey PL, Windham BG, Folsom AR. Physical Activity and Cardiovascular Disease in African Americans in ARIC. Med Sci Sports Exerc. 2013;45(5):901–907. doi: 10.1249/MSS.0b013e31827d87ec - DOI - PMC - PubMed
    1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation. 2023;147(8):e93–e621. doi: 10.1161/CIR.0000000000001123 - DOI - PMC - PubMed
    1. Winstein CJ, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98–e169. doi: 10.1161/STR.0000000000000098 - DOI - PubMed
    1. Michael KM, Allen JK, Macko RF. Reduced Ambulatory Activity After Stroke: The Role of Balance, Gait, and Cardiovascular Fitness. Archives of Physical Medicine and Rehabilitation. 2005;86(8):1552–1556. doi: 10.1016/J.APMR.2004.12.026 - DOI - PubMed

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