Overall Hospitalizations for Stroke Decrease, but Racial Disparities Remain

Wuwei (Wayne) Feng MD MS FANA Assistant Professor, Department of Neuroscience Department of Health Science & Research Medical University of South Carolina Stroke Center The Center of Rehabilitation Research in Neurological ConditionsMedicalResearch.com Interview with:
Wuwei (Wayne) Feng MD MS FANA
Assistant Professor, Department of Neuroscience
Department of Health Science & Research
Medical University of South Carolina Stroke Center
The Center of Rehabilitation Research in Neurological Conditions

MedicalResearch: What are the main findings of the study?

Dr. Feng: Stroke hospitalization rate is decreasing in the elderly, but increasing in the young/middle aged population, but this increase is mainly driven by the increase in blacks (not in whites) which incurred persistent racial disparity in stroke. It has tremendous economic impact as outlined in the paper. Of hospital charges totaling $2.8 billion over 10-year period, $453.2 million (16.4%) are associated with racial disparity (79.6% from patients <65 years).

By way of background:

84,179 stroke hospitalizations occurred in South Carolina from 2001 to 2010. Blacks accounted for 29,846 (35.5%) and whites accounted for 54,333 (64.5%) of the strokes. Among blacks, 50.4% were <65 years of age compared to 29.6% among whites. The overall stroke hospitalization rate decreased over the 10-year period. There was a significant reduction in stroke hospitalization rate in the older (≥65 years old) populations, for both blacks and whites.

Whereas, in the younger populations (<65 years old), the overall rate of stroke hospitalizations actually increased significantly; however this increase was only associated with black patients. For example, the hospitalization rate per 100,000 for young blacks was 121 in 2001, 139 in 2005 and 142 in 2010 (a 17.3% increase from 2001).

This racial disparity was more severe in the younger group with the highest disparity seen in the 45-54 year age groups for both ischemic strokes (having a clot) and intra-cerebral hemorrhagic strokes.


MedicalResearch: Were any of the findings unexpected?

Dr. Feng: Yes. The results are completed unexpected. We did not expect to see the persistent racial disparity in the middle-aged population.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Feng: Clinicians should be more vigilant of young patients presenting with stroke-like symptoms, especially in those young people with several vascular risk factors. Generally stroke-like symptoms were attributed to others disease conditions by patients.  Clinicians should aggressively treat and modify vascular risk factors, such as diabetes, dyslipidemia, diabetes, weight control and smoking cessation.

For patients, they should stay healthy, eat and exercise well, start a healthy life style when they are still young. Do annual check with physician, identify and treat underlying diseases, such as high blood pressure, diabetes and hyperlipidemia, at an early stage, to prevent stroke down the road.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Feng:

1) We need to monitor the trends of this increase in stroke hospitalization in the middle age population;

2) We need to do a better job to quantify the long term cost of younger-age strokes we were only able to quantify the cost with acute care);

3) The impact of early obesity/diabetes, hypertension and hyperlipidemia on stroke incidence in middle age populations;

4) Expansion of medical access in young to middle aged populations and its impact on the risk of stroke.

Citation:

Persistent Racial Disparity in Stroke Hospitalization and Economic Impact in Young Adults in the Buckle of Stroke Belt

Andrea D. Boan, Wuwei (Wayne) Feng, Bruce Ovbiagele, David L. Bachman, Charles Ellis, Robert J. Adams, Steven A. Kautz, and Daniel T. Lackland

Stroke. 2014;STROKEAHA.114.004853published online before print June 19 2014, doi:10.1161/STROKEAHA.114.004853

 

 

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