Nurose Karim, MD

Skolarus LE, Sharrief A, Gardener H, Jenkins C, Boden-Albala B. Considerations in Addressing Social Determinants of Health to Reduce Racial/Ethnic Disparities in Stroke Outcomes in the United States. Stroke. 2020;51:3433–3439.*

This article aims to address the role of social determinants of health (SDOH) on stroke disparities in order to understand the impact of SDOH on stroke outcome.

SDOH are non-clinical and non-biological social factors that impact health and include fundamental causes of disease such as racism and discrimination; unequal distribution of power, income, wealth, and education; and societal values. This is supported by the statistic provided in the article, for instance; in New York City, Black and Latinx Americans have about two times higher mortality from the Coronavirus Disease 2019 (COVID-19) pandemic than non-Hispanic White Americans. Similarly, in Michigan, Black people had 35% morbidity and 40% mortality rate from COVID-19 despite being 14% of the Michigan population.

Health disparity is defined as a “particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage.” Health disparities adversely affect groups of people who have greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to racism, discrimination, or exclusion. 

The authors then mentioned health disparities and stroke outcome. Over 10% of stroke survivors have a recurrent stroke with up to 30% over 5 years. This recurrence rate is higher in the Black population, though it is not quite certain because of the limited data about the Latinx and Mexican population. Black and Latinx populations face numerous barriers to their health prior to stroke, and, as stroke survivors, these challenges may be enhanced by the disproportionate disability experienced by these vulnerable populations as compared to non-Hispanic White stroke survivors. These populations have limited access to rehabilitation, medical follow-ups, insurance, transportation, and healthy diet, among many other challenges. The author suggested a few strategies to address health care disparities, which are as follows:

1.           Enact local, state, and national policy measures to promote equity.

2.           Access to medical care and the built environment may be more readily within the scope of influence of the stroke community.

Discharge Educational Strategies for Reduction of Vascular Events (DESERVE) was a multiethnic randomized clinical trial that focused on improving self-efficacy through a community worker and patient narrative skills-based intervention, addressing the specific needs of the Latinx population. While not powered for analysis by race/ethnicity, DESERVE demonstrated significant hypertension reduction among Latinx populations, while no differences were found among White and Black participants.

By working together to address SDOH, we believe that stroke disparities can be reduced.

*This article is part of a Focused Updates series of articles on topics related to health equity published in the November 2020 issue of Stroke.