New research reveals that Black and Hispanic individuals who experience a stroke are less likely to receive proven treatments that reduce mortality rates and enhance quality of life, in comparison to their White counterparts.
In cases where strokes are caused by clots, the established gold standard treatment is the administration of a clot-busting medication called alteplase. Additionally, some patients might be eligible for a procedure known as mechanical thrombectomy, wherein a catheter is guided through an artery to extract the clot from the brain.
The recent study, published in the Stroke journal of the American Heart Association (AHA), involved an analysis of 206,853 patient records from 173 medical centers across the US. The findings show that only 16 percent of Black or Hispanic patients received the clot-busting medication, compared to 21 percent of White patients. Moreover, about 7 percent of Black or Hispanic patients underwent a mechanical thrombectomy, while nearly 10 percent of White patients did. The gap was further pronounced among patients covered by Medicaid or those without insurance; Black or Hispanic patients were less likely to receive the thrombectomy procedure than their White counterparts.
Dr. Lorenzo Rinaldo, the lead author of the study and a neurosurgeon at the Mayo Clinic, expressed that these results, although not surprising, remain concerning and frustrating given the consistent demonstration of disparities in stroke care. While previous research had highlighted similar discrepancies, this study aimed to verify if the patterns persisted even after the efficacy of thrombectomy was established in 2015. The study analyzed data from 2016 to 2018.
Dr. Salvador Cruz-Flores, a professor and chair of the Department of Neurology at Texas Tech University Health Sciences Center, noted that while racial disparities in stroke care have been documented, the exact reasons remain unexplored. He indicated that the medical community has hesitated to delve into the possibility of implicit bias or prejudice. Reasons for the disparities might range from biological and socioeconomic factors impacting minorities disproportionately to potential bias from healthcare providers.
For instance, delayed arrival at the hospital could be a factor. Mechanical thrombectomy is most effective within six hours of symptom onset, with benefits extending up to 24 hours in certain cases. Other considerations could involve the exclusion of minority patients from mechanical clot removal due to factors such as milder strokes or reduced access to healthcare.
However, Rinaldo questioned whether the large sample size of the study made such scenarios less likely. He suggested that the issue might be related to timing, as timely identification of stroke symptoms and swift triaging are essential.
Rinaldo emphasized the importance of raising thrombectomy awareness among minority populations and within the healthcare system. He proposed further research to examine disparities in the way patients are prioritized in hospitals serving predominantly minority communities compared to predominantly White populations.
Cruz-Flores highlighted that despite the relatively small absolute differences in treatment outcomes between racial groups, the findings hold statistical significance due to the vast number of participants in the study. Irrespective of the scale of the disparities, he underlined the crucial need to understand the underlying causes.
