on January 6, 2005
Published online before print January 6, 2005, doi: 10.1161/01.STR.0000153065.39325.fd
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Submitted on July 15, 2004
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. * To whom correspondence should be addressed. 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.
Revised on September 28, 2004
Accepted on October 13, 2004
Ethnic Disparities in Stroke. Epidemiology, Acute Care, and Postacute Outcomes
James P. Stansbury PhD*;
Key words: ethnicity • health services research • outcome • racial differences
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Stroke 2005 36: 386-387.
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