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(Stroke. 2000;31:2517.)
© 2000 American Heart Association, Inc.

Letters to the Editor

Ethnicity and Equity: Missing the Point

Matire Harwood, MBChB; Harry McNaughton, FRACP, FAFRM; Kathryn McPherson, PhD Mark Weatherall, FRACP, FAFRM

Rehabilitation Teaching and Research Unit, Wellington School of Medicine, Wellington South, New Zealand

To the Editor:

We read with interest the recent editorial by Fustinoni and Biller on ethnicity and stroke.¹ We feel that ethnicity is a critical aspect of understanding stroke outcomes, particularly within the Pacific rim, and are concerned by what appears a dismissive and cursory approach to the subject.

Despite the variation in definitions of "ethnicity" and "stroke," ethnicity has consistently been shown to be a significant variable for stroke. Ethnic differences in stroke incidence and stroke related mortality have been well documented in the United States, Europe, and New Zealand.^{2 3 4} Differences in risk factor prevalence and management,^{5 6} utilization of services,⁷ and functional and motor impairments⁸ have also been described to a lesser extent.

We agree with the suggestion of Fustinoni and Biller that lower socioeconomic status and associated risk factors may explain some of the stroke burden carried by ethnic minority populations. However, within each social class, premature stroke mortality still remains substantially greater for black men than white men in the United States⁹ and for Maori than non-Maori in New Zealand.¹⁰

Despite the increased stroke incidence rates, increased stroke severity and poor functional outcomes, mortality rates, and discharge destinations are the same for both black and white populations in Europe,³ and our recent work found that such outcomes are better for non-Europeans than Europeans in New Zealand. This challenges the fallacy that ethnic minorities are an unhealthy burden and that "whites" are the "gold standard." We propose that the family unit plays a pivotal part in this important . . . [Full Text of this Article]

O. Fustinoni, MD

Department of Neurology, University of Buenos Aires, Buenos Aires, Argentina

J. Biller, MD

Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana