Ethnic disparities in stroke - Epidemiology, acute care, and postacute outcomes

被引:222
作者
Stansbury, JP
Jia, HG
Williams, LS
Vogel, WB
Duncan, PW
机构
[1] Univ Florida, Dept Anthropol, Gainesville, FL 32611 USA
[2] N Florida S Georgia Vet Hlth Syst, Rehabil Outcomes Res Ctr, Gainesville, FL USA
[3] Stroke Qual Enhancement Res Iniaiat, Gainesville, FL USA
[4] Roudebush VA Med Ctr, Indianapolis, IN USA
[5] Indiana Univ, Coll Med, Dept Neurol, Indianapolis, IN 46204 USA
[6] Univ Florida, Coll Med, Dept Epidemiol & Hlth Policy Res, Gainesville, FL USA
[7] Univ Florida, Dept Hlth Serv Res, Coll Publ Hlth & Hlth Profess, Gainesville, FL USA
关键词
ethnicity; health services research; outcome; racial differences;
D O I
10.1161/01.STR.0000153065.39325.fd
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose - Evidence for ethnic disparities in stroke incidence, severity, and mortality has continued to mount in recent years. However, the picture for disparities in acute management and rehabilitation remains more ambiguous. The objective of this report is to summarize current evidence from stroke epidemiology and studies focusing on disparities in stroke care and disability, suggesting courses for action. Methods - A comprehensive search of current literature on ethnic/racial variation in stroke incidence, mortality, and severity, as well as acute and postacute patient care was performed. Results - Recent evidence unambiguously reaffirms a greater burden of disease in stroke, greater mortality, and greater severity of strokes for blacks. Evidence for disparities in acute and postacute care is less conclusive, as is the evidence for disparities among other ethnic groups. Evidence for health disparities in stroke care across settings, regions, and the continuum of care varies considerably. Conclusions - Minority ethnic groups have higher rates or more severe stroke, but variations in prognosis for clinical outcomes other than mortality remain less certain. There is considerable need for more studies that take into account regional ethnic variations in treatment and outcomes, and for better documentation of stroke outcomes among groups in addition to blacks. Dealing with ethnic disparities in stroke will be served by sustained attention to quality improvement in high-impact areas in stroke care, complemented by initiatives that promote cultural competence.
引用
收藏
页码:374 / 386
页数:13
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