Study: Racial/ethnic care disparities are decreasing for stroke patients
To offset recent data that have shown that minority patients do not receive the same quality of care as whites, a study published this month's Ethnicity & Disease showed that an increasing number of minority stroke patients are now receiving care at top-ranked hospitals.

“Recent trends demonstrate decreasing death rates for white and black stroke patients since 1950. The disease, however, continues to account for significant morbidity and mortality among all populations including ethnic minorities,” wrote Jay J. Shen, PhD, of the University of Nevada at Las Vegas, and Minggen Lu, PhD, of the University of Nevada at Reno.

Age-adjusted stroke mortality rates for whites, African-Americans, Hispanics and Asian/Pacific Islanders were 41.7, 67.1, 34.2 and 37 per 100,000 populations in 2006, respectively. Previously, Sarrazin et al found that that the risk of admission to high-mortality hospitals was 35 percent higher for blacks than for whites in geographic locations with increased residential segregation.

To better understand and evaluate the patterns of racial disparities in high-quality hospitals, Shen and Lu identified 273,532 stroke patients from the 2000 to 2006 National Inpatient Sample. The researchers evaluated mortality risk for stroke patients. Race and ethnicity was categorized as white, African-American, Hispanic/Latino or Asian/Pacific Islander. Hospitals were ranked based on the risk adjusted overall stroke mortality rates and then divided into four groups based on the quartiles of rankings.

A greater number of African-American and Hispanic/Latino patients were admitted to high-quality hospitals in 2006 compared to 2000. “Disparities related to outcomes did not vary in a predictable manner during this period,” the authors wrote.

The researchers said that minority patients were younger and a higher number were uninsured or covered by Medicaid as compared with their white counterparts.

In addition, Shen and colleagues reported that the number of patients admitted to smaller hospitals increased for all racial groups except for Asian/Pacific Islanders. The number of Hispanic patients who were admitted to large hospitals increased; however, the number of Africa-American and Hispanic patients who were admitted to public hospitals declined. In comparison, the percentage of white and Asian patients admitted to public hospitals increased.

More white patients were admitted to higher performing hospital compared with the other ethnic and racial groups. These numbers were 13.2 percent for whites, 10.2 percent for African-Americans, 10.4 percent for Hispanic patients and 6.8 percent for Asians. Whites were less likely to be admitted to lower ranked hospitals (24.9 percent) compared to the other racial groups, 30.3 percent, 32.4 percent and 43.4 percent, respectively.

White and African-Americans were more likely to be admitted to top hospitals compared with Hispanic and Asian patients.

Lastly, the rates of in-hospital mortality were comparable in all racial/ethnic groups except that Hispanic/Latinos who showed lower odds than white patients in 2000 for intracerebral hemorrhage stroke. African-Americans showed lower odds than white patients in 2006 for occlusion of cerebral arteries.

The patterns of stroke admissions to top-hospitals changed significantly between 2000 and 2006 and minority patients were less likely than whites to be admitted to better quality hospitals in 2000. “Although it does not seem to be clear what might be the main reason for this pattern change, the possibility of increased likelihood of admission to academic medical centers as a result of growth in academically affiliated community health centers has to be considered a potential contributing factor,” the authors wrote.

“As we see that stroke mortality has declined in recent years, most likely resulting from multiple factors including greater technological sophistication and quality improvement efforts (e.g., attending hospitals with better quality), minority patients with stroke may have benefited equally comparably to white patients due to multiple national efforts directed toward reducing and eliminating racial disparities in health and healthcare,” the authors wrote.

Shen and colleagues added that more research is needed to gain a better understanding of the underlying factors that contribute to disparities.

“Policies should continue to support healthcare quality improvement efforts that have shown positive effects on outcomes of patients of all racial/ethnic groups. Both public and private programs should be encouraged for helping Asian/Pacific Islander patients to identify and attend high-quality hospitals,” the authors concluded.