The impact of ethnicity on stroke care access and patient outcomes

Making Education Easy

Authors:

Thompson SG et al.

March 28, 2022

Summary:

Non-Europeans, especially Māori, have poorer access to key stroke interventions and experience poorer outcomes, according to a nationwide prospective observational study. The study recruited 2379 adults with confirmed stroke from 28 New Zealand hospitals between 1 May and 31 October 2018 and included 11.5% Māori, 4.8% Pacific peoples, and 4.8% Asian peoples. Compared with Europeans, non-Europeans were younger, had more risk factors, had reduced access to acute stroke units (adjusted odds ratio 0.78; 95% CI 0.60-0.97), and were less likely to receive a swallow screen within 24 hours of arrival (adjusted odds ratio 0.72; 95% CI 0.53-0.99) or MRI imaging (odds ratio 0.66; 95% CI 0.52-0.85). Fewer non-Europeans had a favourable modified Rankin Scale score at 3 (adjusted odds ratio 0.67; 95% CI 0.47-0.96, 6 (adjusted odds ratio 0.63; 95% CI 0.40-0.98) and 12 months (adjusted odds ratio 0.56; 95% CI 0.36-0.88). In addition, Māori were less frequently prescribed anticoagulants (odds ratio 0.68; 95% CI 0.47-0.98) and were more likely to die within 12 months (adjusted odds ratio 1.76; 95% CI 1.07-2.89). The study authors concluded that further optimisation of stroke care, targeting high-priority populations, is needed to achieve equity.

Comment:

This article not only describes the inequities in a care pathway (for stroke here), and the impacts on outcomes, but specifically mentions Māori-led solutions. The journal’s editors, in commenting on this paper, recommended further solution-focussed research to achieve equity, such as this project from 2020 – https://www.ahajournals.org/doi/ full/10.1161/STROKEAHA.120.032442.

Reference: Lancet Reg Health West Pac. 2022; 20:100358.

Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.