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Black/Hispanic Disparities in a Vulnerable Post-Stroke Home Care Population

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Abstract

Significant racial and ethnic disparities in stroke risk factors, occurrence, and outcomes persist in the USA. This article examines socio-economic and health disparities in a diverse, hypertensive sample of 495 post-stroke Black, non-Hispanic and Hispanic home health patients at risk of a recurrent stroke due to elevated systolic blood pressure (SBP), defined as SBP > 140 mmHg. The article, which analyzes cross-sectional data, focuses on correlates of patients’ SBP—the leading modifiable cause of stroke—and physical function—a key stroke sequela and indicator of post-stroke quality of life. Of the 495 participants, 69.7% were Black, non-Hispanic, and 30.3% Hispanic. Black participants had significantly higher mean SBP than Hispanics. After controlling for multiple potential confounders/predictors, being Black was associated with a 3.55 mmHg elevation in SBP relative to being Hispanic. There were no significant Black/Hispanic differences in physical function measures. Seven independent variables significantly predicted better physical function: being male, younger, having fewer comorbidities, lower BMI, fewer depressive symptoms, higher health literacy, and current alcohol drinking (vs. abstinence). Our data provide a unique comparison of homebound Black and Hispanic stroke survivors at heightened risk of recurrent stroke absent targeted intervention. The finding of a significant Black/Hispanic disparity in SBP is striking in this narrowly defined home health care population all of whom are at risk for recurrent stroke. Priority should be given to culturally tailored interventions designed to link vulnerable home care patients to continuous, responsive hypertension care.

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Acknowledgments

This study was supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number U54NS081765.

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Authors and Affiliations

  1. Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA

    Penny H. Feldman & Margaret V. McDonald

  2. Research Division, Hebrew Home at Riverdale, RiverSpring Health, 5901 Palisade Avenue, Bronx, NY, 10471, USA

    Joseph Eimicke & Jeanne Teresi

  3. Columbia University Stroud Center at New York State Psychiatric Institute, New York, NY, USA

    Jeanne Teresi

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  1. Penny H. Feldman
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  2. Margaret V. McDonald
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  3. Joseph Eimicke
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Correspondence to Margaret V. McDonald.

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All procedures performed in this study were in accordance with the ethical standards of the institution and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Feldman, P.H., McDonald, M.V., Eimicke, J. et al. Black/Hispanic Disparities in a Vulnerable Post-Stroke Home Care Population. J. Racial and Ethnic Health Disparities 6, 525–535 (2019). https://doi.org/10.1007/s40615-018-00551-y

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