Q&A: Variations and Gaps in Stroke Care
Moira Kapral, MD, MSc, FRCPC, who delivered the Edgar J. Kenton III Lecture, sat down with ISC News to discuss her research, her presentation and her hopes for future generations of researchers.
Moira Kapral, MD, MSc, FRCPC, who delivered the Edgar J. Kenton III Lecture “Stroke Disparities Research: Learning From the Past, Planning for the Future” sat down with ISC News to discuss her research, her presentation and her hopes for future generations of researchers.
Dr. Kapral is a professor in the department of medicine at the University of Toronto and director of the Division of General Internal Medicine. She holds the Lillian Love Chair in Women’s Health at the University Health Network/University of Toronto and is a staff physician at the Toronto General Hospital. She is a senior scientist at the Institute for Clinical Evaluative Sciences and the Toronto General Research Institute.
The Edgar J. Kenton III Lecture Award is presented to a senior investigator with recognized contributions in the field of stroke-related race/ethnic disparities. The award honors Kenton, an eminent African American stroke neurologist with a commitment to addressing disparities.
ISC News: Can you explain what stroke disparities your research has focused on?
Dr. Kapral: My research has focused on evaluating potential disparities in stroke care and outcomes in Canada, based on sex/gender, ethnicity, socioeconomic status, immigration status, Indigenous status, rural residence and other factors.
ISC News: What has your research yielded?
Dr. Kapral: We found that compared to men, women receive similar care during hospitalization for stroke or transient ischemic attack (TIA) and are equally likely to adhere to medications for secondary stroke prevention, but they have poorer functional outcomes and are more likely to experience pain and depression after stroke. This suggests that interventions to address issues such as functional status and mood may be important for improving stroke outcomes in women.
Additionally, we found that people who lived in low-income areas had an 18% relative increase in one-year mortality after stroke, compared to those in high-income areas, even within the context of Canada’s universal health care system.
Identifiable risk factors and processes of care explained only 14% of the difference in stroke mortality, suggesting that other factors, such as social determinants of health, may be contributors. We also found that people living in rural areas of Canada, compared to those in urban areas, were more likely to have a stroke (11% relative increase) or die from stroke (21% relative increase). This group was more likely to have risk factors, like smoking and obesity, and were less likely to be screened and treated for risk factors like diabetes and high cholesterol.
ISC News: Why is collecting this research important? Do we have gaps to fill that this research can assist with?
Dr. Kapral: Research describing disparities allows us to identify where variations and gaps in care exist, and whether there are populations or situations where care or outcomes may be particularly poor. This work is a necessary first step in determining where additional research may be required, or where targeted interventions should be developed and deployed to reduce disparities and improve care and outcomes.
ISC News: You talk about the future direction of stroke disparity research. Where is it headed, and what is lacking?
Dr. Kapral: Much of previous disparities research has focused on identifying and documenting whether and where disparities exist, and this is important and necessary foundational work. However, the next phase of stroke disparity research will also need to examine the underlying causes of these disparities, recognize the importance of intersecting social identities (for example, the interaction between factors like age, sex, and immigration status on stroke outcomes) and move from descriptions of disparities to identifying possible solutions.
ISC News: What role do social determinants of health and structural racism play in moving from descriptions to solutions, and promoting involvement of underrepresented groups in medicine and research?
Dr. Kapral: There is increasing recognition that differences in medical care account for only a small proportion of the observed disparities in health outcomes, and that social determinants of health (for example, economic stability, education, neighborhood environment) and the sequelae of structural racism are important drivers of health disparities. This suggests that the solutions extend beyond medical care, and policy interventions are required. Biomedical researchers might benefit from increased collaboration with public health experts and social scientists, and from participatory research with affected communities to develop solutions.
We also know that there is underrepresentation of women and racial and ethnic minority groups in academic medicine and research, that this lack of representation can have negative consequences for the quality and scope of medical research, and that strategies are needed to increase representation.
ISC News: How does your talk align with Edgar J. Kenton III’s legacy?
Dr. Kapral: It is a tremendous honor to give this lecture, and I hope that it reflects Dr. Kenton’s legacy in focusing on reducing disparities in stroke and vascular care and in striving to improve health outcomes for all.
ISC News: What is your advice for early career researchers?
Dr. Kapral: Identify mentors and sponsors who can provide opportunities and help you achieve your goals. Seek out existing networks that provide research infrastructure, data and expertise. Persevere in your endeavors because rejection is common. Find joy in belonging to a community of researchers and clinicians.
ISC News: What do you hope attendees will do when they return to their practices after hearing you speak?
Dr. Kapral: I hope attendees will reflect on the legacy of Dr. Edgar J. Kenton, will appreciate the importance of studying disparities in stroke care and outcomes, and will be inspired to participate in future efforts to address the underlying drivers of these disparities.
