Black-White Disparity in Stroke Deaths Due To More Strokes in Blacks Interview with:

George Howard, Dr.P.H. Professor of biostatistics Birmingham School of Public Health University of Alabama

Dr. George Howard

George Howard, Dr.P.H.
Professor of biostatistics
Birmingham School of Public Health
University of Alabama What is the background for this study? What are the main findings?

Dr. Howard: What has been known for many decades is that death rates from stroke are much higher in the black than white population, particularly between the ages of 45 – 65 (or maybe even a little older). These racial differences in stroke are among the greatest disparities for any disease, clearly it is a priority to reduce this disparity.

However, there are two reasons more blacks could die from a disease:

1) more blacks get the disease, or

2) once you get the disease, it is more likely to kill blacks.

The implications of knowing which of these is the major contributor is profound. If the driving force is more blacks are having more stroke, then we need to focus out attention on activities before stroke occur. For example, prevention of the greater prevalence of hypertension and diabetes in blacks, and also reducing the differences in the control of blood pressure and glucose. However, if the driving force is a higher chance of death in blacks once stroke occur, then we need to focus on the disparities in how black stroke patients are cared for compared to white stroke patients. That is, the former requires community-based efforts, while the latter requires hospital-based efforts.

What we found was that nearly all the difference was that blacks are having more strokes … not that they are more likely to die once stroke occurs. What should readers take away from your report?

Dr. Howard: The both patient care and research to reduce the disparities in stroke need to focus on stroke PREVENTION … not stroke care. What recommendations do you have for future research as a result of this study?

Dr. Howard:  We need to go “up stream” in the causal pathway to better understand what leads blacks to be more likely to have a worse risk factor profile (notably hypertension and diabaetes). In addition, we need to understand why blacks are so much less likely to have their blood pressure and glucose levels controlled. Is there anything else you would like to add?

Response: Only that this is a first step … it is important to understand why a problem exists before making efforts to fix the problem. We hope that this research provides that target, so we know where to try to make changes reduce these remarkable disparities in death from stroke. Thank you for your contribution to the community.


George Howard, Claudia S. Moy, Virginia J. Howard, Leslie A. McClure, Dawn O. Kleindorfer, Brett M. Kissela, Suzanne E. Judd, Fredrick W. Unverzagt, Elsayed Z. Soliman, Monika M. Safford, Mary Cushman, Matthew L. Flaherty, Virginia G. Wadley, and for the REGARDS Investigators. Where to Focus Efforts to Reduce the Black–White Disparity in Stroke Mortality: Incidence Versus Case Fatality? Stroke, June 2016 DOI: 10.1161/STROKEAHA.115.012631

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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