Part of this may be because Black and Hispanic women had more severe strokes, and were able to receive more appropriate intensive care at residential facilities than would be possible if they were discharged from the hospital to their homes, says a lead author of the study, Trudy Gaillard, PhD, RN, an associate professor at Florida International University’s College of Nursing and Health Sciences in Miami. “Survivors of severe strokes are less likely to return to work or to be independent in basic activities of daily living,” Dr. Gaillard says. “It is also associated with greater caregiver burden, adversely affecting their health and quality of life,” Gaillard adds. “This is likely why, in our study, more patients with severe strokes were not discharged home but rather to a care facility.”
‘Reassuring’ Results on Post-Stroke Care
Even after researchers accounted for stroke severity and several other factors that can influence outcomes for stroke survivors, they still found the youngest Black and Hispanic women in the study were more likely to be discharged to skilled nursing or rehabilitation facilities than the oldest white women. Black and Hispanic women 65 to 74 years old were more than four times more likely than white women 85 and up to be discharged to an institutional setting even after researchers accounted for insurance status, stroke severity, stroke type, and chronic health problems. Similarly, Black and Hispanic women 75 to 84 years old had more than double the chance of being discharged to skilled nursing or rehab facilities. “Our study provides reassuring results that stroke minorities, in our population, are benefiting at least equally, if not more, from post-hospital stroke care in regard to disposition location,” Gaillard says. The study examined data on 1,587 older women in Miami who were treated for stroke between April 2014 and March 2019. Overall, about 27 percent of the women were Black, 38 percent were Hispanic, and 35 percent were white. Results are preliminary, and have not been published in a peer-reviewed medical journal, which would involve verification of the analysis by independent experts. “These findings — that Black and Hispanic stroke survivors under the age of 85 having higher odds of receiving post-acute rehabilitation — are a welcome change,” says Nneka Ifejika, MD, MPH, the section chief of stroke rehabilitation at the University of Texas Southwestern Medical Center in Dallas. But it would be helpful to see how the odds of rehabilitation compare for women within the same age groups, instead of comparing younger Black and Hispanic women to white women over 85, says Dr. Ifejika, who wasn’t involved in the study. The unanswered question in the data presented is what would happen if stroke survivors of the same age range, with similar medical conditions, stroke type, and insurance walk through the door. This apples-to-apples comparison would make it easier to understand any disparities in the care women receive when they leave the hospital, Ifejika says.
Other Studies Highlight Disparities in Stroke Prevention and Treatment
Previous research has found that Black and Hispanic people are more likely to have strokes than white people, and less likely to receive treatments to prevent stroke or limit disability when they do have a stroke. A study published in February 2020 in Stroke, for example, found that Black people were 51 percent more likely to have a stroke than white people — largely driven by the increased risk among Black women 70 and older. This study also found that Hispanic people were 48 percent more likely to have a stroke than white people — in this case primarily due to lower education levels and lower rates of insurance. Another study, published in July 2016 in JAMA Neurology, focused on racial disparities in stroke treatment. This study found that nonwhite stroke patients were 20 percent less likely to receive intravenous thrombolysis, a clot-busting therapy designed to limit damage from a stroke, and 43 percent less likely to get a procedure to reopen the carotid artery to prevent another stroke. Making matters worse, this study also found that nonwhite patients were more likely to undergo interventions that have not proved effective for stroke patients: feeding tubes in the stomach, surgery to reduce swelling in the brain, and incisions in the windpipe to aid breathing. One reason Black and Hispanic women have a higher risk of stroke than white women is that they’re more apt to have several risk factors for stroke, such as high blood pressure, type 2 diabetes, high cholesterol, obesity, and a family history of stroke, Ifejika says. But implicit bias and structural racism may also play a role in their increased stroke risk. “There is a paucity of effective culturally competent interventions to address the healthcare needs of these populations,” Ifejika says. “As a minority stroke rehabilitation physician, I am not surprised that this disparity exists.”
Unique Stroke Symptoms for Women
Women are also at greater risk for stroke than men, and may experience some symptoms that are distinct from those seen in men, according to the American Heart Association (AHA). Common stroke symptoms include:
Sudden numbness or weakness in the face, arm, or leg, especially on one side of the bodySudden confusion, trouble speaking or understanding speechSudden deterioration in vision in one or both eyesSudden dizziness, loss of balance, or trouble walkingSudden severe headache
But women may report other symptoms, according to the AHA:
Fainting or loss of consciousnessShortness of breathSudden behavioral changesAgitationHallucinationNausea or vomitingSeizuresHiccups
“It is important that all women, especially older women, know the signs and symptoms of a stroke,” Gaillard says.
