African-Americans and Stroke: Alternative Sources of Information

Research Databases - Nursing

Stroke Disparities

The incidence and mortality rates for stroke differ markedly along racial lines, with African-Americans having a much higher risk of stroke and death from stroke compared to Whites (Howard, 2013). Approximately 40% of this difference can be explained by the variables included within the Framingham Stroke Risk Score, while another 10% can be explained by socioeconomic status. Other contributing factors probably include differential health care access and quality. Accordingly, the Surgeon General of the United States (2014) recently issued a statement describing government actions being taken to reduce health disparities and published a list of recommendations for providers. Among these recommendations are focusing on at-risk communities, improving care access and quality, improved provider training, and better evaluations of stroke risk among minorities. For these reasons I have chosen to focus on stroke incidence and mortality in African-Americans.

270 words for each database

Database #1: U.S. Centers for Disease Control and Prevention (CDC)

URL: http://www.cdc.gov/dhdSP/data_statistics/index.htm

The CDC (2014) maintains a significant amount of information about stroke on its website. The CDC is an agency within the Department of Health and Human Services dedicated to the prevention of morbidity and mortality due to disease, injury, or life style choices. Among this massive collection of information, a substantial proportion of which is peer-reviewed and available through the Library of Medicine, is source material focused on stroke in the American population. This material includes evidence-based fact sheets, direct access to the CDC journal Morbidity and Mortality Weekly Report, online tools, white papers, and commissioned reports.

Although most of the fact sheets are focused on the general population, at least one provides information specific to the African-American demographic. The "Take control of your heart: It's all in the ABCS" fact sheet provides general recommendations for minimizing stroke risk, but scattered within these recommendations are statistics concerning the African-American population. Among the online tools is an Interactive Atlas of Heart Disease and Stroke, which provides detailed geographic distributions of stroke outcomes by race, gender, and age. The statistical resources include the Behavioral Risk Factor Surveillance System (GRFSS) survey data, Morbidity and Mortality Chartbook from the National Heart, Lung, and Blood Institute (NHLBI), and the American Heart Association. The Chartbook from the NHLBI, for example, presents the leading causes of death for African-Americans in 2008, stratified by gender. Stroke is the 4th and 3rd leading cause of death for Black males and females, respectively. The CDC website is therefore a rich trove of evidence-based recommendations, study findings, and statistics related to stroke among African-Americans.

Database #2: The Internet Stroke Center

URL: http://www.strokecenter.org/professionals/resources/guidelines-consensus-statements/

The Internet Stroke Center is the product of a number of agencies and institutions, including the National Institutes of Health Specialized Programs of Translational Research in Acute Stroke (SPOTRIAS) Network, National Institute of Neurological Disease and Stroke, Washington University School of Medicine, and the University of Texas Southwestern Medical Center. The purpose of the site is to provide a centralized resource for researchers and clinicians interested in all things stroke, where current best practice recommendations can be found, along with meeting presentations, published accounts, correspondence between experts, and the Stroke Trials Registry. The main categories of guidelines available on this site are the following: (1) general stroke, (2) acute stroke management, (3) stroke prevention, (4) stroke recovery, (5) organizing stroke care, (6) diagnosis, (7) imaging, and (8) pediatric stroke.

The majority of the information provided in this database is from foreign sources and would therefore contain little to no information about stroke in African-Americans; however, the website represents an exhaustive source of best-practice recommendations for stroke prevention and treatment from experts from all over the globe. This source material therefore represents standards against which the care being provided to African-Americans can be compared. There are also a number of guidelines and recommendations available from American sources. The National Stroke Association, for example, issued guidelines for the prevention of first stroke and mentions that hypertension occurs in African-Americans more frequently, at an earlier age, and in a more severe form. The Internet Stroke Center can therefore serve as a portal and database for all things stroke, in addition to providing best practice recommendations specific to the African-American population.

Database #3: Stroke Belt

URL: http://www.strokebelt.org/

The Stroke Belt website represents a collaborative effort by a number of stakeholders interested in reducing the incidence of stroke, primarily in the Southeastern United States. These stakeholders include health care providers from academic institutions and private clinics, representatives of local, state, and national governments, non-profit groups, pharmaceutical companies, and importantly, minority groups. The focus of the Stroke Belt is to reduce stroke incidence, improve prevention and treatment, and increase stroke education among stroke belt communities. Among the notable accomplishments are the Coverdell Acute Stroke Registry, development of the Stroke Center concept, and the creation of number of stroke prevention programs. The most obvious source material maintained on this website is from Stroke Belt meetings, which occur every two years. The presentations of each speaker can be downloaded for the 2012 and 1014 meetings.

Since the Stroke Belt is based in the Southeastern United States there is a strong concern about stroke incidence in African-Americans. A number of the speakers who have presented at past meetings addressed this issue. For example, George Howard presented a talk titled "Blood pressure and racial disparities in stroke" at the 2012 meeting and in 2014 presented an "Update on stroke epidemiology." The Stroke Belt website can therefore serve as a source of information related to stroke in African-Americans by experts in the field.

Database #4: National Stroke Association

URL: http://www.stroke.org/stroke-resources

The National Stroke Association (NSA) is a non-profit organization dedicated to reducing the incidence of stroke through prevention and education, in addition to improving the care provided to stroke survivors. Clicking on the resources tab on their website opens up a menu of options, including the StrokeSmart Magazine, the NSA newsletters, a database of news items related to stroke, and a resource library consisting of fact sheets, decision aids, multimedia presentations, publications, and other resources. The focus of the long list of available fact sheets is primarily on helping the public understand the diseases they suffer from, how to reduce the risk of stroke, and how to recover following a stroke. A quick search of the fact sheets did not reveal any discussing health disparities among racial minorities. A quick search of the multimedia offerings, however, retrieved two recent NSA presentations dealing with this topic. Among the three available decision aids was a stroke risk scorecard, but this did not address the impact of minority status. The publications consist of brochures, a wallet card, worksheets, a comprehensive guide, and a directory, but only one brochure addresses stroke risk among African-Americans. While this database does not contain peer-reviewed scientific publications, it does represent a rich resource for patients interested in learning about preventing, treating, and recovering from stroke. The education material provided by the NSA therefore serves as a ready source of educational aids that providers can use to help patients understand stroke prevention and treatment, including a few dealing with concerns specific to African-Americans.