Matthew Edwardson, MD

Levine DA, Morgenstern LB, Langa KM, Skolarus LE, Smith MS, and Lisabeth LD. Does Socioeconomic Status or Acculturation Modify the AssociationBetween Ethnicity and Hypertension Treatment Before Stroke? Stroke. 2013

Mexican Americans have higher stroke rates than non-Hispanic whites, but the reasons for this disparity remain unclear. Levine and colleagues sought to determine if lack of treatment for HTN prior to stroke among Mexican Americans might explain this difference after adjusting for socioeconomic status (SES) and acculturation.

The authors used data from the Brain Attack Surveillance in Corpus Christi project (BASIC) to retrospectively determine whether patients admitted to the hospital with a diagnosis of stroke took anti-HTN medications prior to admission. They compared the use of anti-HTN medications between Mexican Americans and non-Hispanic whites and then adjusted this comparison based on education level (as a proxy for SES) and English proficiency (as a proxy for acculturation).

The results showed no difference between use of anti-HTN medications among Mexican Americans and non-Hispanic whites even after adjusting for SES and acculturation. The only factor which contributed to the level of pre-stroke anti-HTN use was whether or not patients had health insurance. 93% of the Mexican American patients in this study were insured, which may explain the overall negative results. Interestingly, both Mexican Americans and non-Hispanic whites of higher SES demonstrated a trend toward lower anti-HTN use. It remains unclear whether the results from this study are generalizable to other Mexican American populations. If so, the authors have ruled out one more possible explanation for the high stroke rates among Mexican Americans.