A decade of racial and ethnic stroke disparities in the United States
Jose Gutierrez1, Olajide A Williams
1From the Department of Neurology, Columbia University Medical Center, New York, NY.
Insights
Stroke disproportionately affects minority groups, particularly African Americans, due to higher rates of uncontrolled vascular risk factors and hypertension. This leads to significantly increased stroke risk in these populations compared to non-Hispanic whites.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Stroke is a leading cause of death and disability in the US, with higher incidence and prevalence in specific geographic areas and minority groups.
- Disparities in stroke rates are linked to socioeconomic factors, healthcare access, and differential prevalence and control of vascular risk factors, including hypertension.
- African Americans experience a higher burden of stroke compared to non-Hispanic whites, suggesting underlying disparities in risk factor management.
Purpose of the Study:
- To investigate the geographic and racial differences in stroke incidence and prevalence in the United States.
- To identify factors contributing to stroke disparities, focusing on vascular risk factors and their control across different racial groups.
- To examine the specific impact of hypertension control on stroke risk among African Americans compared to non-Hispanic whites.
Main Methods:
- Utilized data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.
- Compared the prevalence and control rates of vascular risk factors, including hypertension, between African Americans and non-Hispanic whites.
- Analyzed the association between suboptimal blood pressure control and stroke risk, considering racial differences.
Main Results:
- African Americans exhibit significantly higher rates of suboptimal control of vascular risk factors and unhealthy lifestyles compared to non-Hispanic whites.
- Black individuals are more prone to high blood pressure, less likely to have it controlled once diagnosed, and face a 3-fold higher stroke risk for every 10-mm Hg increase in systolic blood pressure compared to whites.
- These findings highlight a 'triple threat' of hypertension in the Black population contributing to stroke disparities.
Conclusions:
- Suboptimal control of vascular risk factors, particularly hypertension, is a major driver of stroke disparities between African Americans and non-Hispanic whites.
- Addressing disparities in hypertension diagnosis, control, and management is crucial for reducing the disproportionate burden of stroke in minority populations.
- Public health initiatives should focus on improving healthcare access and promoting healthier lifestyles to mitigate stroke risk in vulnerable communities.
Abstract:
Stroke is the fourth leading cause of death and the leading cause of long-term disability in the United States. Stroke incidence and prevalence is not uniform. It occurs more frequently in some geographical areas of the United States and the rates are higher in minority groups.(1,2) Some proposed causes for these disparities include increased rate of vascular risk factors that disproportionally affect some minority groups, differential effect of hypertension on stroke risk across racial groups, lack of access to health care and other social determinants of health, suboptimal control of risk factors, and although lacking substantive data to date, an inherited predisposition to stroke associated with genetic differences. The Reasons for Geographic and Racial Differences in Stroke (REGARDS) investigators found that the rate of suboptimal control of vascular risk factors and unhealthy lifestyles were significantly greater in African Americans compared to non-Hispanic whites (NHW).(2) Moreover, regarding high blood pressure (BP), a triple threat has been described: blacks are not only more likely to have high BP, they are less likely, once diagnosed, to have their high BP controlled, and this suboptimal control has been shown to confer a stroke risk that is 3 times higher among blacks compared to whites for every 10-mm Hg increase in systolic BP (SBP).(3.)
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