Disparities in Stroke Care Persist

It is accepted that time-to-treatment plays a large role in stroke outcomes. Understanding the factors that affect the time it takes for people to receive care is thus essential to improving stroke-related morbidity and mortality. In research presented at the Society of Neurointerventional Surgery (SNIS) 18th Annual Meeting, data showed that in the US, the socially defined category of race predicts how quickly people receive endovascular treatment. 

A multicenter registry study analyzed the records of 34,596 patients from 206 through 2020 at 42 hospitals in 12 states, and found that Black persons with stroke, in comparison with white persons with stroke, were 27% less likely to arrive at a hospital within 5 hours of symptom onset, 30% less likely to be diagnosed with large vessel occlusion, and 28% less like to have thrombectomy. 

“Black patients in the United States consistently experience worse health outcomes than White patients, leading to staggering racial health gaps,” commented lead author Adam Wallace, MD, in the SNIS press release. “It’s imperative that we take steps to ensure that all stroke patients are treated with the utmost urgency and receive optimal care, including surgery when appropriate, so they can experience the highest quality of life after stroke.” Dr. Wallace is a neurointerventional surgeon at Ascension Columbia St. Mary’s Hospital in Milwaukee, Wisconsin.

Another study reviewed data from 305 patients collected between 2016 and 2020 to find out how factors including race, socioeconomic status, health insurance coverage, and driving distance to a stroke center influenced how quickly individuals received stroke surgery. 

In the study, researchers measured the time between each patient’s stroke onset and the beginning of surgery, with a focus on the time from onset to arrival at the hospital. The socially defined category of race was a major factor in determining how long it took for people with stroke to arrive at the hospital. Other factors included driving distance, the patient’s stroke severity level, and whether a patient discovered the stroke symptoms upon waking. 

The researchers found that income, age, and gender were not predictors for timely access to care among this group of patients.

“Your race, zip code, or socioeconomic status should not determine whether you make it home from the hospital after a stroke,” said Ricardo Hanel, MD, PhD, endovascular neurosurgeon and co-medical director of the Baptist Stroke & Cerebrovascular Center, Jacksonville, FL. “The study shows that equity of access to care is critically important in achieving excellent outcomes for all.”