This Article Full Text Full Text (PDF) All Versions of this Article: 36/2/374    most recent 01.STR.0000153065.39325.fdv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Stansbury, J. P. Articles by Duncan, P. W. Search for Related Content PubMed PubMed Citation Articles by Stansbury, J. P. Articles by Duncan, P. W. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Choosing a Doctor or Health Care Service Stroke Related Collections Health policy and outcome research Other Ethics and Policy Other Stroke Treatment - Medical Epidemiology Cerebrovascular disease/stroke Other Treatment Emergency treatment of Stroke Related Article

(Stroke. 2005;36:374.)
© 2005 American Heart Association, Inc.

Special Report

Ethnic Disparities in Stroke

Epidemiology, Acute Care, and Postacute Outcomes

James P. Stansbury, PhD; Huanguang Jia, PhD; Linda S. Williams, MD; W. Bruce Vogel, PhD Pamela W. Duncan, PhD, FAPTA

From the Rehabilitation Outcomes Research Center (J.P.S., H.J., W.B.V., P.W.D.), North Florida/South Georgia Veterans Health System, Gainesville, Fla; the Department of Anthropology (J.P.S.), University of Florida, Gainesville, Fla; the Stroke Quality Enhancement Research Initiative (H.J., L.S.W., P.W.D.), Gainesville, Fla; the Roudebush VA Medical Center (L.S.W.), Indianapolis, Ind; the Department of Neurology (L.S.W.), College of Medicine, Indiana University, Indianapolis, Ind; the Department of Epidemiology and Health Policy Research (W.B.V.), College of Medicine, University of Florida, Gainesville, Fla; and the Department of Health Services Research (P.W.D.), Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Fla.

Correspondence to Dr James P. Stansbury, Department of Anthropology, University of Florida, 1112 Turlington Hall, Gainesville, FL 32611-7305. E-mail jstansbu{at}ufl.edu

Background and Purpose— Evidence for ethnic disparities in stroke incidence, severity, and mortality has continued to mount in recent years. However, the picture for disparities in acute management and rehabilitation remains more ambiguous. The objective of this report is to summarize current evidence from stroke epidemiology and studies focusing on disparities in stroke care and disability, suggesting courses for action.

Methods— A comprehensive search of current literature on ethnic/racial variation in stroke incidence, mortality, and severity, as well as acute and postacute patient care was performed.

Results— Recent evidence unambiguously reaffirms a greater burden of disease in stroke, greater mortality, and greater severity of strokes for blacks. Evidence for disparities in acute and postacute care is less conclusive, as is the evidence for disparities among other ethnic groups. Evidence for health disparities in stroke care across settings, regions, and the continuum of care varies considerably.

Conclusions— Minority ethnic groups have higher rates or more severe stroke, but variations in prognosis for clinical outcomes other than mortality remain less certain. There is considerable need for more studies that take into account regional ethnic variations in treatment and outcomes, and for better documentation of stroke outcomes among groups in addition to blacks. Dealing with ethnic disparities in stroke will be served by sustained attention to quality improvement in high-impact areas in stroke care, complemented by initiatives that promote cultural competence.

Key Words: ethnicity • health services research • outcome • racial differences

Related Article:

Editorial Comment—Ethnic Disparities in Stroke: Epidemiology, Acute Care, and Postacute Outcomes

Stanley Tuhrim
Stroke 2005 36: 386-387. [Full Text] [PDF]

This article has been cited by other articles:

				K. J. Ottenbacher, J. Campbell, Y.-F. Kuo, A. Deutsch, G. V. Ostir, and C. V. Granger Racial and Ethnic Differences in Postacute Rehabilitation Outcomes After Stroke in the United States Stroke, May 1, 2008; 39(5): 1514 - 1519. [Abstract] [Full Text] [PDF]

				S J Sarker, P U Heuschmann, I Burger, C D A Wolfe, A G Rudd, N C Smeeton, and A M Toschke Predictors of survival after haemorrhagic stroke in a multi-ethnic population: the South London Stroke Register (SLSR) J. Neurol. Neurosurg. Psychiatry, March 1, 2008; 79(3): 260 - 265. [Abstract] [Full Text] [PDF]

				Prevalence of Stroke--United States, 2005 JAMA, July 18, 2007; 298(3): 279 - 281. [Full Text] [PDF]

				E. Onukwugha and C. D. Mullins Racial Differences in Hospital Discharge Disposition among Stroke Patients in Maryland Med Decis Making, May 1, 2007; 27(3): 233 - 242. [Abstract] [PDF]

				C. D.A. Wolfe, D. O.C. Corbin, N. C. Smeeton, G. H.E. Gay, A. G. Rudd, A. J. Hennis, R. J. Wilks, and H. S. Fraser Estimation of the Risk of Stroke in Black Populations in Barbados and South London Stroke, August 1, 2006; 37(8): 1986 - 1990. [Abstract] [Full Text] [PDF]

				C. D.A. Wolfe, D. O.C. Corbin, N. C. Smeeton, G. H.E. Gay, A. G. Rudd, A. J. Hennis, R. J. Wilks, and H. S. Fraser Poststroke Survival for Black-Caribbean Populations in Barbados and South London Stroke, August 1, 2006; 37(8): 1991 - 1996. [Abstract] [Full Text] [PDF]

				K. M. Cockroft Unruptured Cerebral Arteriovenous Malformations: To Treat or Not to Treat Stroke, May 1, 2006; 37(5): 1148 - 1149. [Full Text] [PDF]

				A. J. Mullard, M. J. Reeves, B. S. Jacobs, R. U. Kothari, G. L. Birbeck, K. Maddox, S. Stoeckle-Roberts, S. Wehner, and Paul Coverdell National Acute Stroke Registry Mich Lipid Testing and Lipid-Lowering Therapy in Hospitalized Ischemic Stroke and Transient Ischemic Attack Patients: Results From a Statewide Stroke Registry Stroke, January 1, 2006; 37(1): 44 - 49. [Abstract] [Full Text] [PDF]

				K. Carter, C. Anderson, M. Hacket, V. Feigin, P. A. Barber, J. B. Broad, R. Bonita, and on behalf of the Auckland Regional Community Strok Trends in Ethnic Disparities in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003 Stroke, January 1, 2006; 37(1): 56 - 62. [Abstract] [Full Text] [PDF]

				T. S. Harwell, C. S. Oser, N. J. Okon, C. C. Fogle, S. D. Helgerson, and D. Gohdes Defining Disparities in Cardiovascular Disease for American Indians: Trends in Heart Disease and Stroke Mortality Among American Indians and Whites in Montana, 1991 to 2000 Circulation, October 11, 2005; 112(15): 2263 - 2267. [Abstract] [Full Text] [PDF]