Stroke risk factors remain higher among Black adults in U.S.
Physicians can help bridge the gap in these disparities.
Black adults are 50% more likely to have a stroke compared to their white counterparts, according to the U.S. Department of Health and Human Services Office of Minority Health.
“The No. 1 modifiable risk factor contributing to this disparity is uncontrolled blood pressure,” said Richard Benson, MD, PhD, director of the Office of Global Health and Health Disparities for the National Institute of Neurological Disorders and Stroke.
Dr. Benson, who will be part of the Mind Matters: Unraveling Disparities in Brain Health session on Wednesday, said blood pressure control rates in the U.S. have worsened over the last decade, with significantly lower rates of control among people from racial and ethnic minority groups.
“Non-Hispanic Black persons have 10% lower control rates compared to their non-Hispanic White counterparts,” he said.
Kelly-Ann Patrice, MB, BS, assistant professor of vascular neurology at the University of Arkansas for Medical Sciences, said social determinants of health within at-risk populations place them at higher risk and drive these disparities.
“Higher rates of poor health literacy, lower socioeconomic status and decreased access to health care can negatively impact effective implementation of primary stroke prevention strategies,” she said.
Those strategies and what physicians can do about them will be the topic of Wednesday’s session.
Dr. Benson said health equity is “imperative to achieving an optimal, healthy, productive, cohesive society,” and doctors can work to achieve this worthy goal.
“We need to look at the impact of racism and implicit bias on disparities in stroke care, and also examine the effect of the pandemic and the use of newer technologies on access in diverse populations,” he said. “There are also potential sex differences within the brain that may modify efficacy of prevention and treatment regimens.”
Dr. Patrice said physicians can play a significant role in bridging the gap in health care disparities, including increasing their focus on equitable hospital care.
“When a patient presents to the hospital with an acute stroke, we have already missed the boat with regards to primary prevention,” she said. “Equitable hospital care gives us a second chance by ensuring patients receive timely acute stroke interventions and access to rehabilitation to reduce stroke morbidity and mortality, which has far-reaching socioeconomic implications for our patients as well as the wider community.
“It also provides an opportunity to improve health literacy and give at-risk populations increased access to resources.”
Another way to bridge the disparity gap is an increased focus on diversity and inclusion in research and data in clinical trials — both on research teams and within the patient population being studied.
“A diverse workforce and inclusion of people with a lived experience at study development are paramount to increasing the participation of underrepresented groups in clinical studies,” Dr. Benson said. “The impact of people from diverse backgrounds seeing representations of themselves on the clinical team and participating in the design of the study can help build trust and boost participation in clinical studies.”
Dr. Patrice said diversity in research is necessary to ensure that the scientifically rigorous evidence used to guide stroke management effectively targets the patients who are more disproportionately affected.
“Increased diversity and inclusion at all stages of a clinical trial can ensure that the trial is conducted in a culturally sensitive manner and potentially increase minority participation,” she said.