Racial and Ethnic Disparities in Stroke Incidence and Outcomes

Rates of stroke in the United States either continue to decline or appear to have plateaued over time. However, due to changing demographics, namely the aging population and growing diversification by race and ethnicity, healthcare disparities persist and may widen with regards to stroke prevalence among diverse racial and ethnic communities. This review focuses on updated data and trends regarding racial/ethnic disparities in stroke and stroke outcomes.

Black Americans continue to have higher risk for incident stroke, with poorer functional and cognitive outcomes and more difficulty with self-care, mobility, and return to household activities. Disparities in stroke risk for Hispanic Americans are present but vary by region in the United States and Hispanic country of origin/subpopulation. For example, stroke disparities for Mexican Americans in South Texas may be narrowing over time but the population continues to have worse functional and cognitive outcomes, compared to non-Hispanic White stroke survivors. Differences in stroke mortality are present, but may be modified by stroke type (ischemic, hemorrhagic) and according to long-term follow up of mortality outcomes, especially among Black Americans with worse survival rates after stroke. Racial/ethnic stroke and stroke outcome disparities are modified by sex and social determinants of health, specifically factors related to socioeconomic status, education, and healthcare access and quality.

Disparities by race and ethnicity are identified for stroke incidence, mortality, functional outcomes, and cognitive outcomes. Research must expand to broaden understanding of the role of social determinants of health in driving or exacerbating racial and ethnic stroke disparities.