The Association of Race and Sex with the Underuse of Stroke Prevention Measures

Department of Neurology, Mount Sinai School of Medicine, New York, New York 10029, USA.
Journal of stroke and cerebrovascular diseases: the official journal of National Stroke Association (Impact Factor: 1.67). 07/2008; 17(4):226-34. DOI: 10.1016/j.jstrokecerebrovasdis.2008.02.003
Source: PubMed


Underuse of effective stroke prevention measures has been demonstrated in the general population. Blacks and Hispanics are at increased risk of recurrent stroke relative to white non-Hispanics. More profound underuse of prevention measures may contribute to this disparity. In this study we attempted to compare the degree of underuse of diagnostic and treatment strategies in patients of these racial/ethnic groups with recent ischemic stroke.
At 4 participating urban hospitals, patient charts were reviewed with regard to the completeness of the diagnostic evaluation, discharge treatment regimen, and stroke risk factor and antithrombotic medication use at 6 months postdischarge.
Of 501 patients hospitalized with acute ischemic stroke, almost all received electrocardiograms and brain imaging, 75% had carotid artery evaluations, and 70% had serum lipid determinations. Blacks and women were less likely to have complete evaluations. At discharge, 88% of patients received antithrombotic medications and 89% of patients were prescribed antihypertensive medications appropriately, but only 65% were prescribed lipid-lowering medications appropriately, with blacks least likely to receive appropriate prescriptions. At 6 months poststroke, of the 200 patients with data available for evaluation, 72% exhibited underuse of at least one stroke prevention measure. Blacks (81.6%) were more likely to experience underuse than Hispanics (62.5%) or whites (66.7%). Women were more likely to receive incomplete inhospital evaluations and discharge regimens.
There is clinically important underuse of effective diagnostic and prevention measures in each of the groups studied, especially among blacks.

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    • "However, other aspects of the diagnostic evaluation including imaging of brain, vessels, and heart did not show a racial difference [17]. Tuhrim et al. reported that black stroke patients were less likely to receive complete diagnostic evaluations and less likely to receive appropriate secondary prevention measures [18]. These racial disparities in evaluation and treatment may be explained by differences in insurance or socioeconomic status, patient mistrust of the medical system, and/or clinician bias. "
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