American Heart Association

Monthly Archives: November 2020

Author Interview: Dr. Mitchell S. V. Elkind on “Approaches to Studying Determinants of Racial-Ethnic Disparities in Stroke and Its Sequelae”

Dr. Mitchell S. V. Elkind
Dr. Mitchell S. V. Elkind

Dr. Mitchell S. V. Elkind, MD, MS, FAAN, FAHA, is a Professor of Neurology and Epidemiology at Columbia University Irving Medical Center. He is the Head of the Division of Neurology Clinical Outcomes Research and Population Sciences (NeuroCORPS). Presently, he serves as the president of the American Heart Association.

He is interviewed by Dr. Melanie R. F. Greenway, MD, vascular neurology fellow at Mayo Clinic in Jacksonville, Florida.

They will be discussing the paper “Approaches to Studying Determinants of Racial-Ethnic Disparities in Stroke and Its Sequelae,” published in the November 2020 issue of Stroke. The article is part of a Focused Updates series of articles on topics related to health equity.

Dr. Greenway: To start, I would like to thank you for writing this comprehensive review on studying race-ethnic disparities in stroke as part of this unique series of articles in Stroke on health equity. This review provides an important framework for anyone embarking on their own epidemiologic research, as well as those of us reading and interpreting the race-ethnic disparities literature that is rapidly evolving. To start, you describe health disparities between groups as “a difference with a difference.” Can you explain what you mean by this?

Dr. Elkind: Disparities refer to differences in health that result from a very specific set of reasons, such as social, economic, or environmental disadvantage. There are many reasons why people may have different health outcomes, but when we talk about disparities, we are referring to differences that are often due to being part of a particular race or ethnic group, or to being part of another group that has historically experienced disadvantage.

By |November 5th, 2020|clinical|0 Comments

Article Commentary: “Inaugural Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving Symposium”

Ericka Samantha Teleg, MD

Towfighi A, Benson RT, Tagge R, Moy CS, Wright CB, Ovbiagele B. Inaugural Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving Symposium. Stroke. 2020;51:3382–3391.*

Health disparities in gender, class, race, and ethnicity exist. In the scientific community, this is a sad truth as well. Many of us researchers, physicians, and scientists are underrepresented. The Health Equity and Actionable Disparities in Stroke: Understanding and Problem-solving (HEADS-UP) symposium is meant to shatter these disparities, breaking through such barriers of social injustice, color, and caste systems. Researchers are key to resolve this challenge and advocate for the underrepresented minorities (URM) in the health system. This community will enable us to identify the differences in the biological, social, and environment that affect the continuum of care access and ensure quality care is given to underrepresented individuals.

The term URM stands for underrepresented minorities, and, as a consequence, clinicians and scientists will unite — hence, URM faculty will engage in research endeavors to reduce such differences among the underserved and/or low-income communities and make certain of the representation of the group in large clinical trials. There is strength in numbers, and clearly HEADS-UP is a voice for URM scientists.

By |November 4th, 2020|clinical|0 Comments

Article Commentary: “Stroke Disparities: From Observations to Actions: Inaugural Edward J. Kenton Lecture 2020”

Ericka Samantha Teleg, MD

Sacco RL. Stroke Disparities: From Observations to Actions: Inaugural Edward J. Kenton Lecture 2020. Stroke. 2020;51:3392–3405.*

Disease equalizes us all. However, health disparities exist across all cultures, race, ethnicity, and socioeconomic status. It is at this particular time that it can never be more important that Dr. Ralph Sacco pays tribute to Dr. Ed Kenton in this inaugural lecture to address stroke disparities, emphasize the necessity to shift from observations into actions, and provide a foundation for initiating interventions that are culturally tailored for the benefit of all humans. The advocacy for social justice in health is indeed in effect.

Dr. Sacco highlighted the definition of health disparity, that it involves inequality in a condition or rank between groups. More so, it is the lack of equality, opportunity, treatment, or status. He highlights the design and the results of the Northern Manhattan Study (NOMAS), which was set up in the 1990s. The NOMAS study is a population-based study that assessed stroke incidence, stroke subtypes, risk factors, and outcomes. What has started as a population-based stroke incidence and surveillance study has evolved over time. Dr. Sacco tells us that initially, it began as three case-control studies, as they matched stroke cases by age, gender, and race to community-derived controls collected through random-digit dialing. Over time, this was expanded and evolved into a prospective cohort study likened to the Framingham Study. The NOMAS study is meant to be a lifelong follow-up on these particular groups. The Northern Manhattan area in the United States is a densely populated tri-ethnic community of Hispanic population as a majority. Dr. Sacco gives us the history with the importance of collecting stroke data and using this registry to evaluate characteristics of the stroke cases. Over the years, the prospective cohort has been in the hands of advocate and leaders, and an important message that he tells us is the role of young investigators, and that value of collaborating for such important endeavors can remain lifelong.

By |November 3rd, 2020|clinical|0 Comments

Addressing Racial/Ethnic Disparities in Stroke Care: Thinking Outside the Box

Lauren Peruski, DO

Levine DA, Duncan PW, Nguyen-Huynh MN, Ogedegbe OG. Interventions Targeting Racial/Ethnic Disparities in Stroke Prevention and Treatment. Stroke. 2020;51:3425–3432.*

Racial/ethnic disparities in health care have been clearly documented and result from unequal treatment. This occurs as a result of biased populations and healthcare systems in the literature that fail to translate to the real-life circumstances and the diverse world that we live in today. If there existed racial/ethnic equality in medicine, an estimated 700,000 deaths may have been avoided. The authors of this article understand the magnitude of this inequality and have eloquently summarized selected interventions aimed at reducing racial/ethnic disparities in stroke prevention and treatment. 

Community-based Interventions
Hypertension is one of the most common, and deadly, identified vascular risk factors. It is also one of the top contributors to racial/ethnic disparities in health. Black individuals tend to develop hypertension at an earlier age and have a more severe course of illness than White individuals. Similarly, Hispanic patients are more likely to have worse blood pressure control than White patients. Fortunately, there have been interventions that have been effective in improving control of blood pressure in under-represented racial and ethnic populations. One of the most successful interventions took place in barbershops. In Black male barbershop customers with uncontrolled hypertension, the combination of health promotion by barbers, alongside medication management in the barbershop by specialty-trained pharmacists, resulted in decreased blood pressure at 6 and 12 months. The combination of a barber with a pharmacist appeared to have a more substantial effect than the barber promoting health alone. The pairing of medical professionals with similarly prominent, respected, and trusted members of under-represented racial and ethnic communities may be a way to approach health promotion moving forward.

By |November 2nd, 2020|clinical|0 Comments