Saturday, September 02, 2006

Race Plays Role in Stroke's Aftermath

(HealthDay News) -- One of the first nationwide studies of stroke's long-term effects finds it seriously lowers survivors' quality of life, and that black survivors tend to fare worse than whites.

"The disparity between the black and white populations is actually wider among the stroke population than the non-stroke population," said study author Dr. Jipan Xie, a public health analyst at the U.S. Centers for Disease Control and Prevention in Atlanta.

The report is published in the Sept. 1 online issue of Stroke.

Xie's team looked at federal data from the Household Component of the Medical Expenditure Panel Survey, conducted in 2000 and 2002. They focused on 39,680 adults, including 1,040 who had survived a stroke.

Patients were evaluated by a number of measurements for physical and mental health, physical functioning, pain, energy/fatigue, general health, social functioning and limitations due to physical health, emotional problems or mental health.

The researchers also assessed the patient's ability for self-care, usual activities, pain/discomfort and anxiety/depression. They had patients score their health status on a scale of 0 to 100, with the best possible health rated as 100.

Compared to people without any history of stroke, stroke survivors scored 4.1 percent lower on mental health scores, 7.9 percent lower on physical health scores, 6.9 percent lower on daily ability scores and 7.2 percent lower in rating their overall health.

These quality-of-life disparities were even greater between white stroke survivors and black or Hispanic stroke survivors, the researchers added.

Xie thinks that these data will help health-care professionals understand the longer term impact of stroke, especially since she expects to see many more people surviving strokes.

"We need to know what the national level of the impact of stroke is," Xie said. "As mortality has been declining, we expect more people to become stroke survivors. And quality of life is important health information -- we now have information on the quality of life among stroke survivors."

Xie believes that improvements in initial stroke care and rehabilitation can boost quality of life for stroke survivors.

"Stroke causes severe reduction in quality of life. So, it is important to improve the quality of care of stroke," Xie said.

The findings come as "no real surprise," added Dr. Norman M. Kaplan, a clinical professor in the division of hypertension at the University of Texas Southwestern Medical Center. "Strokes are becoming even more prominent as people get older. When people have a heart attack, they usually get over it, but a stroke leaves part of the brain impaired. So, there is always some loss of quality of life after a stroke."

The main cause of stroke is high blood pressure, Kaplan said. "Blacks have more strokes than whites," he noted. "The main reason is that they don't get control of their blood pressure because they don't get as much medical attention," usually because lower incomes restrict their access to care.

Improvements in prevention, initial treatment and access to post-stroke rehabilitation can help stroke survivors lead better, more productive lives, another expert said.

"More programs are needed that promote high-quality medical care, which could have an impact on patient outcomes," said Dr. Eric Smith, associate director of acute stroke services at Massachusetts General Hospital in Boston. "We also need steps to insure that high-quality medical care is available for everyone, regardless of race or ethnicity."

Smith believes too few patients are receiving the powerful clot-busting drug tPA when stroke first strikes.

"There [also] needs to be better preventive strategies for stroke," he said. "Also, persons who have less access to medical insurance may not be able to arrange the same level of rehabilitation as others."

More information
Find out more at the American Stroke Association.

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