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Minority Health

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Poorer outcomes from stroke are more common among minorities than whites

A new study found that black, Hispanic, and Asian/Pacific-Islander patients all had greater neurologic impairment than whites from stroke due to cerebral artery occlusion. On the other hand, Asians, but not blacks or Hispanics, suffered greater neurologic impairment than whites from stroke due to carotid artery occlusion. Overall, Asian patients (more of whom were older and female) suffered the highest rate of deaths and most severe neurologic impairment for both types of arterial disease, although the reasons for this disparity are unclear.

Higher rates of stroke-related neurologic impairment in blacks and Hispanics suggested an association related to high cholesterol and type 1 diabetes. Thus, initiatives to treat and prevent diabetes and high cholesterol in these groups should be undertaken to reduce health disparities, suggests Jay J. Shen, Ph.D., of Governors State University. In the study, which was supported by the Agency for Healthcare Research and Quality (HS13056), Dr. Shen and his colleagues used national data from the 2000 National Inpatient Sample of the Healthcare Cost and Utilization Project to examine the patterns of disparities in acute care outcomes of ischemic stroke among white, black, Hispanic, and Asian/Pacific-Islander patients (13,316 patients with carotid artery-related stroke and 33,149 patients with cerebral artery-related stroke).

Among stroke patients with carotid artery occlusion, 62.5 percent of whites had paralysis compared with 71.2 percent of blacks, 69.1 percent of Hispanics, and 74 percent of Asians. Among patients with cerebral artery occlusion, 69.9 percent of whites had paralysis compared with 76.6 percent, 70.7 percent, and 77.8 percent for black, Hispanic, and Asian patients, respectively; the corresponding percentages of patients in coma were 1.8 percent, 1.6 percent, 2.3 percent, and 2.7 percent.

More details are in "Racial disparities in the pathogenesis and outcomes for patients with ischemic stroke," by Dr. Shen, Elmer L. Washington, M.D., M.P.H., and Lisa Aponte-Soto, in the March 2004 Managed Care Interface, pp. 28-34.

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