International Stroke Conference
February 19–21, 2020
Charlotte Zerna, MD, MSc
Go Red For Women was created in 2004 and is a comprehensive platform designed to increase women’s health awareness and focus on research into women’s cardiovascular health, and it is meant to empower female patients to take charge of their own heart and brain health to improve outcomes. This year’s International Stroke Conference featured multiple sessions under the Go Red For Women track. The inaugural Paolo de Rango Memorial Session about sex differences in stroke was moderated by Nada El Husseini (Durham, NC) and Amytis Towfighi (Los Angeles, CA).
Salvador Cruz-Flores (El Paso, TX) emphasized that differences have to be avoidable, unjust, and unfair to constitute a disparity and can occur in any one group when compared to the most advantaged group. These differences systematically place socially disadvantaged groups at further disadvantage in regards to their health. Such disparities or social determinants of health are, for example, the adoption of health-promoting behavior and exposure to unhealthy/stressful living and working conditions, as well as access to health care and other public services. Measuring health disparity necessitates an indicator variable for one’s health, an indicator variable for one’s social position, and the ability to compare the health indicators across social position strata. A recent study by Rinaldo and colleagues was able to show the racial and ethnic disparities in the utilization of acute treatment for ischemic stroke in the United States.1 Intravenous alteplase was offered to 4.3% more white patients compared to black/Hispanic patients. About 10% more were also admitted to an endovascular-capable center, and 2.8% more received endovascular treatment.
Leslie Skolarus (Ann Arbor, MI) presented examples of innovative and multidisciplinary approaches to promote equity across the stroke care continuum. Starting from the REACH OUT study (a phase 2 randomized factorial clinical trial) to address blood pressure in a majority African American city over the STROKE READY study that taught school children to recognize the signs of stroke in their parents to the SUCCEED study (community clinic randomized controlled trial) that aims to decrease blood pressure as a secondary stroke prevention. All these studies have and are working with vulnerable populations and often use everyday technology to either deliver an intervention in a new way or focus on a new intervention target, often redesigning health care roles along the way.
Thomas Leung (Hong Kong, Hong Kong) brought to the audience’s attention that low-/middle-income countries bear > 80% of the global stroke burden despite having only about 20% of the total economic resources. Stroke occurs much earlier in life in low-/middle-income countries and often affects patients at their productive peak, especially in rural areas. Some reasons are poor primary health care and risk factor control, as well as low health literacy.
Bernadette Boden Albala (Irvine, CA) closed the session by speaking about how to address and prevent health disparities. First steps to strive for health equity would be a stroke surveillance system for risk factor, incidence/prevalence, and outcome evaluation. Once the underlying mechanisms related to the health disparity are understood, evidence-based strategies can be implemented for stroke prevention (on a population-based level, targeting people at all cardiovascular risk levels, including such things as tobacco control, promotion of exercise, and less salt and sugar intake), preparedness (protocol-driven implementation of an ambulance system and stroke center triage), acute treatment, and rehabilitation. Challenges include limited resources, the necessary collaboration of all stakeholders, and continuing education and task shifting through a community approach. It was suggested that primary stroke prevention strategies should be integrated with other prevention strategies for major non-communicable diseases to be more cost-effective, and necessary revenue could result from taxation on tobacco, salt, sugar and alcohol.
1. Rinaldo L, Rabinstein AA, Cloft H, Knudsen JM, Castilla LR and Brinjikji W. Racial and Ethnic Disparities in the Utilization of Thrombectomy for Acute Stroke. Stroke; a journal of cerebral circulation. 2019;50:2428-2432.