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

  • Penny H. Feldman
  • Margaret V. McDonaldEmail author
  • Joseph Eimicke
  • Jeanne Teresi
Article

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.

Keywords

Stroke Racial/ethnic disparities Home health care Outcomes 

Notes

Acknowledgments

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

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Research Involving Human Participants

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.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  1. 1.Center for Home Care Policy & ResearchVisiting Nurse Service of New YorkNew YorkUSA
  2. 2.Research DivisionHebrew Home at Riverdale, RiverSpring HealthBronxUSA
  3. 3.Columbia University Stroud Center at New York State Psychiatric InstituteNew YorkUSA

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