Long-term stroke death rates are higher among Black Medicare patients
Black patients had higher rates of kidney failure, dementia and diabetes, while COPD was more common among whites.
A long-term look at Medicare patients shows that Black patients who have an ischemic stroke (blocked blood flow to the brain) die at a higher rate than white patients, even after accounting for preexisting health conditions, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2021.
The virtual meeting is geared toward researchers and clinicians dedicated to the science of stroke and brain health.
Much of what is known about such strokes is limited to the early, acute phase. Mystery about the early recovery period and secondary prevention, which affects long-term chances of survival, spurred a deeper dive.
WHAT'S THE IMPACT?
Researchers analyzed data on 744,044 Medicare beneficiaries ages 65 and older who had been treated at U.S. hospitals for ischemic stroke between 2005 and 2007. Overall, 85.6% were white, 9.9% were Black and 4.5% were of other races or ethnic groups.
Black patients had higher rates of kidney failure, dementia and diabetes. Atherosclerosis and chronic obstructive pulmonary disease (COPD) were more common in white patients.
Over a 10-year period, the data found that overall, the death rate was about 75%. Black patients had the highest death rate at 76.4%, followed by whites at 75.4%; and the death rate for those of other races or other ethnic groups was 70.3%.
Even after adjusting for differences in pre-existing health problems, the risk of death within 10 years after stroke was about 4% higher for Black patients than white patients. However, the stroke death risk was about 8% lower for those of other races.
Importantly, within the first year after hospital discharge for ischemic stroke, the death rate for Black patients started to climb slightly in comparison to whites and other races, and these differences continued over the decade.
The big racial discrepancies in long-term stroke survival manifested mainly within the first year after a stroke, suggesting that the next step for healthcare is to optimize secondary prevention and post-stroke care for all groups, which will be the focus of future research, authors said.
THE LARGER TREND
A number of racial, geographic and age-related disparities have been unearthed during the COVID-19 pandemic. Data published in JAMA, for instance, found inequities in telehealth usage:
Women were 8% less likely to participate in a video visit than men; Latinx patients were 10% less likely than white patients; and Black patients were 35% less likely than white people. Patients with lower household incomes were also less likely to conduct a video visit, with those making less than $50,000 being 43% less likely.
Blue Cross Blue Shield of Massachusetts recently signaled its intent to address racial disparities and injustice through a set of new initiatives, including new charitable investments.
The investments include: a grant program to support not-for-profits led by Black, Indigenous and other people of color (BIPOC); a first-to-market approach to collecting race and ethnicity data to address inequities in the care members receive; expanding marketing efforts to better reach a more diverse audience, with messages focused on addressing gaps in care and improving overall health; and new investments and support for minority-owned businesses.
These efforts will be enabled by new $350,000 Racial Equity and Justice Grants that support BIPOC-led not-for-profit organizations focused on addressing racial injustice in Massachusetts communities.
Focus on Health Equity
In our ongoing coverage, we report on the challenges, opportunities and success stories as work continues to build a healthcare system that works for everyone.
Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com
