Preliminary research presented at the American Stroke Association (ASA) International Stroke Conference that took place March 17–19, 2021, added to a growing body of research that seeks to better understand why Black Americans are more likely to die of stroke than any other racial group. Researchers looked at data from nearly 750,000 Medicare patients who had a stroke between 2005 and 2007, and followed their long-term health over the next 10 years. The overall death rate among all patients was 75 percent. But they found that, even after adjusting for preexisting health conditions, Black patients were 4 percent more likely than white patients to die within 10 years of having a stroke. Black patients who died also tended to be younger and were more often women. The researchers also found that Native Americans, Hispanic Americans, and Asian Americans, which were all put in one category, were as a whole 8 percent less likely than white patients to die within 10 years of having a stroke. The U.S. Office of Minority Health reports that Native Americans, Asian Americans, and Hispanic Americans have similar stroke occurrence and death rates as white Americans. On the other hand, Black Americans are 50 percent more likely to have a stroke than white Americans, and Black women are 70 percent more likely than white women to die of stroke. The study authors believe the disparity is rooted in access to follow-up care. “We need to be thinking about the long-term trajectory of stroke survivors, not just the acute event. This is particularly important because our findings suggest that the early recovery period may set up the long-term survivorship of patients,” says Judith Lichtman, PhD, MPH, the codirector of the center for neuroepidemiology and clinical neurological research at Yale University in New Haven, Connecticut, who led the study, noting that hospitals need to ensure that all patients are able to access follow-up visits, rehabilitation, and medications after they’re discharged.
Lack of Access to Follow-Up Care Is Only Part of the Problem
Olajide A. Williams, MD, a professor of neurology at Columbia University in New York City, argues that improving a person’s chance of surviving a stroke in the long term extends far beyond follow-up care. He points to the REGARDS study, an ongoing health study of more than 30,000 people. With funding from the National Institutes of Health (NIH), the study seeks to better understand why Black Americans and those who live in the Southern United States have higher rates of stroke and related brain diseases. Early on, researchers found that only about half the disparities between stroke risk in Black and white Americans could be explained by traditional risk factors — such as hypertension, smoking, and heart disease — or socioeconomic factors. Dr. Williams emphasizes that the remaining half were unidentified drivers that were significantly raising the stroke risk among Black Americans. “I believe that it’s the effects of socially structured stressors,” says Williams. “Chronic social stressors that are tied to structural racism, indignities tied to interpersonal racism, and structural racism that impacts employment, incarceration, and housing have a drastic impact on health. And whatever way you look at it, you will see stark differences between these factors between Blacks and whites.” These inequalities directly affect health. A study published in April 2019 in the journal Psychoneuroendocrinology found that the experience of racism appeared to cause inflammation in African Americans. Such inflammation raises a person’s risk of chronic diseases like heart and kidney disease. According to Williams, people who experience chronic racism also have increased blood pressure, and their blood pressure may not slow when they sleep — the normal occurrence called nocturnal dipping of blood pressure. This could be an explanation for the inflammation, and it causes damage throughout the body. “It’s akin to the wear and tear on the body that comes with constant emotional battering,” he says. Williams notes that studies on race and health that look at only one factor, such as long-term patient care, fail to capture the whole story of what is driving health disparities. “It’s very difficult to [compare] apples to oranges; we have to look at context. Yes, there is provider bias, but the greatest challenge is the different contexts that Black and white people live in. The areas where Blacks live are often stripped of resources, and that makes these environments hostile to health,” says Williams. “That is where we need to make the greatest gains if we need to close this gap.”
