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| Racial and gender disparities found in stroke diagnosis |
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03 February 2006
Blacks, Hispanics, and women are more likely than other patients to receive a discharge diagnosis of ill-defined stroke, study results suggest. Adjustment for variables including emergency room (ER) presentation and diagnostic procedures reduced, but did not eliminate the racial and gender disparities.
"In 2000, one in five Medicare hospital claims for stroke involved an ill-defined diagnosis at discharge, a disturbing proportion given the need for an accurate diagnosis to guide evaluation and treatment," the US research team writes. Of the 445,452 Medicare claims for stroke made in 2000, 65% were for ischaemic stroke, 21% were ill-defined, 12% were for haemorrhagic stroke, and 2% were for late effects of cerebrovascular disease.
After adjustment for age, Dr Henraya McGruder and co-workers from the Centers for Disease Control and Prevention in Atlanta, Georgia, USA, found that women were 1.30-fold more likely to receive an ill-defined stroke diagnosis. Blacks were 1.31 times and Hispanics 1.27 times more likely to receive a discharge diagnosis of ill-defined stroke. Adjustment for other variables including ER presentation and diagnostic procedures reduced the increase in risk of an ill-defined stroke diagnosis to 1.22-, 1.14-, and 1.18-fold in women, Blacks, and Hispanics, respectively.
"We found no evidence to suggest that ER physicians discriminated in procedure use between these groups," the investigators write in the journal Stroke. "Thus it is possible that other factors related to reaching the ER in time for an accurate evaluation may have influenced the likelihood of receiving an ill-defined diagnosis."
Dr McGruder et al cite evidence that Blacks and Hispanics may be less likely to recognise the major signs of stroke than Whites, and studies suggesting that women and Blacks may have greater delay times to admission, and that Blacks are less likely to arrive at the ER via ambulance. "Although this explanation is speculative, greater public health efforts are needed to increase awareness in the general population about stroke signs and the need for prompt emergency transport."
Reference:
Stroke 2006; online publication.
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