乌鸦传媒

Racial disparities in stroke care and outcomes continued to persist well after the introduction of endovascular therapy (EVT), according to data from the Get With The Guidelines (GWTG) stroke registry.

The good news is that EVT utilization generally picked up across all racial groups since 2015 when the major trials were published, and there was a significant narrowing of the gap between Black and white patients compared with the pre-2015 era, reported Faheem Sheriff, MD, of the University of Texas Health Science Center at Houston, at the American Stroke Association's virtual International Stroke Conference (ISC).

Hispanics and Asians continued to undergo EVT at similar rates as white peers from 2012-2015 to 2015-2019. Meanwhile, "other" groups actually had 25% better EVT utilization rates than white patients starting in 2015.

Since 2015, Black, Hispanic, and Asian stroke patients have consistently had less in-hospital mortality or discharge to hospice compared with white patients. This did not translate into better functional outcomes at 90 days, however -- in fact, Blacks and Asians had worse longer-term outcomes, while Hispanics fared similarly to whites.

Overall, the captured 302,965 patients with acute ischemic stroke from the second quarter of 2012 to second quarter of 2019; 42,422 people underwent EVT.

Sheriff cited systemic racism, lower utilization of EMS and later arrival to EVT-capable centers, lack of awareness regarding acute stroke symptoms, and mistrust of the healthcare system as contributors to the observed racial disparities.

In an earlier ISC session, a panel highlighted structural and interpersonal racism as factors in worse cerebrovascular health among minorities.

Mechanisms are varied: for example, research has linked interpersonal racism and microaggressions to the development of hypertension, and upstream factors such as housing and environment have been tied to education and health, according to Olajide Williams, MD, MS, of New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York City.

The lack of racial diversity in the academic and physician workforce also has implications for cerebrovascular health equity, given that Black and Hispanic clinicians are more likely to care for underserved communities, and patient-physician race concordance is associated with positive health outcomes, said Gbenga Ogedegbe, MD, MPH, of NYU Grossman School of Medicine, also in New York City.

Various stakeholders will ultimately play roles in addressing health equity barriers.

Medical educators have to stop teaching imprecise categories of race and tying certain diseases to racial groups without the context of social determinants of health (e.g., asthma in Black patients), said Salvador Cruz-Flores, MD, of Texas Tech University Health Sciences Center El Paso.

On the industry side, there is work needed to recruit underrepresented minorities in human trials, according to Kenneth Maynard, PhD, of Takeda Pharmaceuticals.

The NIH's Richard Benson, Sr., MD, of the National Institute of Neurological Disorders and Stroke, noted that his agency is planning a large funding announcement for research on structural racism and health disparities.

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