Racial disparities, geography influence stroke mortality, study shows

In the United States, one out of every 20 deaths is caused by stroke. And yet, based on new research, race and geography prevent some of the most vulnerable from obtaining effective treatments.

The findings come from a report published Wednesday in the journal Neurology. Researchers found stroke patients living in the Northeast states had more than twice the odds of receiving tPA -- a powerful anti-coagulant that can break up the clot causing the stroke -- than those living in the Midwest and the South.

The researchers also found race also played a role in determining the patients who received treatment. African-Americans who were evaluated for stroke severity were 26 percent less likely to get the medication. Other minorities faced 17 percent higher odds of not securing the drug.

Overall, a quarter of patients eligible for the medication did not receive it.

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Researchers analyzed data from nearly 62,000 patients tracked from 2003 to 2011 in a voluntary national hospital database set up by the American Heart Association. The group of patients all experienced ischemic strokes -- those caused by blood clots in the brain and not those caused by burst blood vessels -- and arrived at a hospital within two hours after their symptoms began. The drug is most effective when used within the first three hours after the onset of symptoms.

Lee Schwamm, vice-chairman of the neurology department at Massachusetts General Hospital and the lead author of the report, said he is not sure why so many people are not given access to tPA. But, he speculates the issue may lie in doctors not recognizing stroke in the first place.

"Some of this may be a failure of recognition rather than a failure to provide treatment to a person who presents these symptoms," he said.

According to the latest data from the Centers for Disease Control and Prevention, stroke is the fifth leading cause of death in the United States. The condition afflicts more than 795,000 people each year and kills nearly 130,000 of them.

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African-Americans and Hispanics are more likely to have a stroke and die from the condition than whites.

High blood pressure, cholesterol and smoking raise the risk of having a stroke. And while half of the American population lives with one or more of these risk factors, a CDC survey in 2005 revealed less than 40 percent of respondents could name all of the symptoms of a stroke. Those include sudden numbness, lack of coordination and slurred speech

Mike Wacholder, 74, had a stroke while walking into his office in Troy, New York, four years ago. He first noticed himself leaning to the left as he walked. Although he went to the doctor within four hours of his first symptoms, his physician sent him back to work. He finally received a diagnosis nearly 11 hours later after collapsing and being rushed to the emergency room. While his brain function remains largely intact, the stroke disabled the left side of his body.

Wacholder said his experience taught him stroke patients need to advocate on their own behalf. Many patients are not educated enough about stroke to talk about their care, he said.

"The patient has to be able to express what's on their mind," he said.

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Wacholder's long wait before arriving at the hospital eliminated his chance to obtain tPA.

Yet, even those who meet the recommended window of opportunity to obtain treatment fall through the cracks. Patients who arrived at the hospital more than 45 minutes after the onset of their symptoms had a 21 percent higher chance of not receiving tPA. At the hospital, those who waited more than 25 minutes for a CT scan were 41 percent less likely to receive the treatment.

Susan Gaunt, stroke program coordinator and stroke clinical nurse specialist at Gwinnett Medical Center outside of Atlanta, said providers in her facility are frustrated because so few patients arrive at the hospital in time to qualify for tPA.

Less than half of them use an ambulance for transport, she said, which means physicians and nurses must use up some initial care time doing routine medical protocol like placing an IV instead of pinpointing a diagnosis.

"Time is really drained," she said.

Georgia is located in America's "Stroke Belt," the region of the nation where stroke rates are high. According to the Georgia State Department of Health, stroke is the fourth leading cause of death in the state. In 2013 alone, the condition led to 21,000 hospitalizations and more than a billion dollars in medical costs.

Gaunt has worked on community outreach across the Peach State since 2004, educating the public about stroke and its risks.

"We do do a lot of community events," Gaunt said. "But it doesn't seem to be enough."

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