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Vital Signs

African Americans Missing Out on Stroke Treatment

African-American men and women, who are at a greater risk for strokes and are more likely to die from them than any other racial or ethnic group, face a racial gap in receiving new stroke treatments, according to studies by the American Heart Association.

Researchers led by scientists from the University of California at San Francisco found that whites are five times more likely than African Americans to receive emergency clot-busting treatment for stroke, tissue plasmingen activator (TPA).

The study’s findings, published in a recent issue of Stroke: Journal of the American Heart Association showed that among 1,195 stroke patients in some of the nation’s top hospitals, 49 patients (4.1%) received TPA. But the use of the drug in African Americans was significantly lower than in whites--only three blacks (1.1%) received the TPA, compared to 42 whites (5.3%). According to the study, a large racial disparity existed even after statistical adjustment for differences in age, gender, type of insurance and stroke severity.

African Americans have three times as many ischemic strokes, which occur when arteries feeding the brain are blocked by a clot. Ischemic strokes account for approximately 83% of all stroke cases, and TPA is the first proven therapy.

 

Approved by the U.S. Food and Drug Administration in 1996, TPA acts by dissolving blood clots. The drug must be administered within three hours of stroke onset symptoms.
“Society as a whole, not just the medical community, is responsible for the significant racial disparity the study reveals,” says lead author S. Claiborne Johnson, PhD, assistant professor of neurology at the UCSF. “Factors contributing to the problem might include the need for more education on [recognizing the] symptoms of stroke within the African-American community or a greater distrust of the medical system by African Americans. It is possible that the patients are refusing the drug, as it is considered an aggressive, high-risk therapy, and that this isn’t being documented.”

 

“Another possible factor is racial prejudice,” Johnson adds, “though in this case, it most likely would not be because the doctors care less about African Americans, but that they may have preconceived notions about whether African Americans are willing to accept aggressive, risky treatments.”

A smaller study conducted by Steven S. Kittner, PhD, professor of neurology and director of the Maryland Medical Center at the University of Maryland, included 138 patients eligible for TPA, three of whom were black. None of them refused the therapy.

Claiborne says, “Though a more detailed analysis of factors predicting treatment is required, we have to consider the possibility that racism is contributing. If we can’t acknowledge the possibility that racism may be playing a role, we may never be able to correct disparities in health care.”