Stroke Study Cites Racial Disparity


Racial differences in the relationships between doctors and patients make African Americans less likely than whites to receive important stroke preventing procedures even though the risk for stroke is higher among blacks, new research shows.

The findings, published in the medical journal Stroke, add to the growing number of studies demonstrating that health care in America is not colorblind. Previous studies, for example, have indicated that black Americans are less likely than whites to receive such medical procedures as angioplasty, bypass surgery or hip fracture repair.

"This is a very important study that will help us identify potential gaps in how we are delivering health care," said Dr. Marsha Davenport, chief medical officer in the office of strategic planning at the federal government's Health Care Financing Administration.

The new study not only establishes stroke prevention as another area in which African Americans receive less treatment, but also explores the reasons for the differences. Previous research had shown that white patients were three times more likely than blacks to be referred for a type of surgery that unclogs an artery in the neck and thereby reduces stroke risks. But that research had not ruled out the possibility that the differences stemmed from unequal financial situations or a variation in the severity of symptoms.

The new research by Dr. Eugene Oddone of Duke University and his colleagues controlled for those factors and still found that race alone made white patients 50% more likely to be treated.

Oddone focused on stroke because it is the most important contributor to blacks' higher mortality rate.

Across all racial groups, stroke is the third leading cause of death and one of the major causes of disability for American adults.

"This study has broad implications. Across the board, we are seeing differences in management of patients with similar insurance status and similar clinical profiles," said Dr. Kevin Schulman of Georgetown University, whose study last February showed that doctors in the United States are more likely to suggest certain heart disease tests for white males than for women or African Americans.

A stroke occurs when an artery carrying blood to the brain breaks or becomes clogged. As the blood supply is interrupted, brain cells starve for oxygen and die. The loss of brain cells can lead to partial paralysis and sometimes death.

The authors analyzed the medical records of 803 men older than 45 who had been diagnosed with a mini-stroke in four of the best Veterans Affairs medical centers in the country. The researchers determined how eligible the patients were for two procedures--one that searches for blockages in the neck arteries and one that surgically removes blockages. In both cases, black patients eligible for the procedures were less likely than whites to be referred for the work.

The most likely place for race to influence those outcomes, the study concluded, is in the interactions between the doctors, who were mostly white, and their patients.

Oddone warned that the different treatment did not necessarily indicate conscious prejudice on the part of the doctors. Instead, the disparities could come from subtle differences in how doctors interpret information, he said.

"The bias probably represents a subconscious decision. This isn't something doctors know they are doing," Schulman said.

In addition, some of the differences could stem from actions of the patients. Previous work by Oddone's group showed that African Americans were less willing to accept surgery to remove blockages from their neck arteries.

"Very few African Americans can think of a friend or family member who has had the surgery, so they don't have the touchstone to say, 'Someone I know had it and it went well,' " Oddone said.

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