Blacks less likely than whites, Hispanics to get evidence-based stroke care

March 22, 2010, American Heart Association

Blacks hospitalized with the most common type of stroke are less likely than white or Hispanic patients to receive evidence-based stroke care, according to a new study in Circulation: Journal of the American Heart Association.

But this disparity in care improved over time at hospitals participating in the American Heart Association/American Stroke Association's Get With The Guidelines-Stroke quality improvement program, researchers said.

"Previous reports that have identified variances in the quality of care and outcomes among different racial and ethnic groups have been limited in size, have not looked at trends over time and have had inconsistent findings," said Lee H. Schwamm, M.D., lead author of the study and director of the TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston, Mass. "But it's critical to recognize and understand the reasons for these differences in treatment patterns and outcomes so we can develop the strategies needed to eliminate them."

Schwamm and colleagues analyzed in-hospital deaths and examined how frequently 397,257 black, white and Hispanic patients (average age 71) received seven evidence-based stroke care measures at 1,181 hospitals participating in the Get With The Guidelines-Stroke program between 2003 to 2008.

After adjusting for patient and hospital characteristics, the researchers found that received care similar to their white counterparts on most of the seven measures. Black patients, however, were less likely than white or Hispanic patients to receive most of the quality measures:

  • Blacks were 16 percent less likely than whites to receive the clot-busting drug (tPA) and to receive anticoagulants for atrial fibrillation.
  • Blacks were 12 percent less likely than whites to receive prevention and to be discharged with anti-clotting medications.
  • Blacks were 3 percent less likely than whites to receive early anti-clotting medications.
  • Blacks were 9 percent less likely than whites to receive cholesterol-lowering therapy.
  • Blacks were 15 percent less likely than whites and Hispanics were 18 percent less likely than whites to receive smoking cessation counseling.
  • Overall, blacks were 10 percent less likely than whites to receive "defect free care," which is defined as the proportion of patients who receive all of the interventions for which they are eligible.
"An interesting finding is that, despite being less likely to receive the interventions, black patients were less likely to die in the hospital than whites or Hispanics," said Schwamm, chair of the Get With The Guidelines National Steering Committee. "We suspect that's because black patients are more likely to have stroke at younger ages and present with less severe strokes than the other groups."

Researchers also found racial and ethnic differences in stroke-related outcomes at discharge:

  • Black (47.9 percent) and Hispanic (52.6 percent) patients were more likely to be discharged to home compared to white patients (44.0 percent), who were more likely to be discharged to a skilled nursing facility compared to black and Hispanic patients.
  • Black (4.37 percent) and Hispanic (4.90 percent) patients were less likely than white patients (6.06 percent) to die in the hospital.
  • Black (6.60 days) and Hispanic (6.34 days) patients had longer hospital stays than whites (5.49 days).
During the study, Get With The Guidelines-Stroke hospitals significantly improved the quality of stroke care for patients in all three groups, Schwamm said.

"These findings tell us that a focused, systematic quality improvement intervention, such as this, can improve care, regardless of race and ethnicity," he said. "What remains is to identify the causes of these differences in care among ethnic groups so we can develop strategies to eliminate that small but persistent disparity."

Limitations of the study are that participation in Get With The Guidelines-Stroke is voluntary and hospitals that participate are more likely to be larger teaching institutions with a strong interest in stroke care and quality improvement, Schwamm said. So the findings may not represent care at all U.S. hospitals.

Furthermore, reliable information about stroke severity is not always captured in patients' records; so the authors said they're cautious in their conclusions that relate to in-patient death.

Related Stories

Recommended for you

Sweet, bitter, fat: New study reveals impact of genetics on how kids snack

February 22, 2018
Whether your child asks for crackers, cookies or veggies to snack on could be linked to genetics, according to new findings from the Guelph Family Health Study at the University of Guelph.

The good and bad health news about your exercise posts on social media

February 22, 2018
We all have that Facebook friend—or 10—who regularly posts photos of his or her fitness pursuits: on the elliptical at the gym, hiking through the wilderness, crossing a 10K finish line.

Smartphones are bad for some teens, not all

February 21, 2018
Is the next generation better or worse off because of smartphones? The answer is complex and research shows it largely depends on their lives offline.

Tackling health problems in the young is crucial for their children's future

February 21, 2018
A child's growth and development is affected by the health and lifestyles of their parents before pregnancy - even going back to adolescence - according to a new study by researchers at the Murdoch Children's Research Institute, ...

Lead and other toxic metals found in e-cigarette 'vapors': study

February 21, 2018
Significant amounts of toxic metals, including lead, leak from some e-cigarette heating coils and are present in the aerosols inhaled by users, according to a study from scientists at Johns Hopkins Bloomberg School of Public ...

Why teens need up to 10 hours' sleep

February 21, 2018
Technology, other distractions and staying up late make is difficult, but researchers say teenagers need to make time for 8-10 hours of sleep a night to optimise their performance and maintain good health and wellbeing.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.