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(Stroke. 2009;40:1811.)
© 2009 American Heart Association, Inc.

Original Contributions

Use of Stroke Secondary Prevention Services

Are There Disparities in Care?

Joseph S. Ross, MD, MHS; Ethan A. Halm, MD, MPH Dawn M. Bravata, MD

From the Department of Geriatrics and Adult Development (J.S.R.), Mount Sinai School of Medicine, and HSR&D Research Enhancement Award Program and Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Administration Medical Center, Bronx, NY; Department of Medicine (E.A.H.), University of Texas Southwestern Medical Center, Dallas; and the Department of Medicine (D.M.B.), Indiana University School of Medicine and HSR&D Center of Excellence, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis.

Correspondence to Joseph S. Ross, MD, MHS, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1070, New York, NY 10029. E-mail joseph.ross{at}mssm.edu

Background and Purpose— The purpose of this study was to examine whether there are disparities in use of stroke secondary prevention services because disparities in stroke outcomes have been found among older adults, women, racial minorities, and within Stroke Belt states.

Methods— Using the nationally-representative 2005 Behavior Risk Factor Surveillance System, we examined self-reported use of 11 stroke secondary prevention services queried in the survey. We used multivariable logistic regression to examine the association between service use and age, sex, race, and Stroke Belt state residence, controlling for other socio-demographic and health care access characteristics.

Results— Among 11 862 adults with a history of stroke, 16% were 80 or older, 54% were women, 13% were non-Hispanic black, and 23% lived within a Stroke Belt state. Overall service use varied: 31% reported poststroke outpatient rehabilitation, 57% regular exercise, 66% smoking cessation counseling, and 91% current use of antihypertensive medications. Age 80 or older was not associated with lower use of any of the 11 services. Women were less likely to report poststroke outpatient rehabilitation and regular exercise when compared with men (probability values 0.005); there were no sex-based differences in use of the 9 other services. Blacks were less likely to report pneumococcal vaccination when compared with whites, but were more likely to report poststroke outpatient rehabilitation (probability values 0.005); there were no race-based differences in use of the 9 other services. Stroke Belt state residence was not associated with lower use of any of the 11 services.

Conclusions— Use of many stroke secondary prevention services was suboptimal. We did not find consistent age, sex, racial, or Stroke Belt state residence disparities in care.

Key Words: health care • prevention • women and minorities • quality of care