Strokes and African-Americans African-Americans are reported to be nearly twice as likely to experience a stroke as their white counterparts however, African-Americans are much less likely to know the risk-factors and symptoms of stroke or to seek early treatment. The purpose of this study is to examine the issue of African-Americans and stroke. The significance of this study is the additional knowledge that will be added to the already existing base of knowledge in this area of study. The methodology employed in this study is of a qualitative and interpretive nature and has been conducted through a review of literature in this area of study.

Strokes and African-Americans

African-Americans are reported to be nearly twice as likely to experience a stroke as their white counterparts however, African-Americans are much less likely to know the risk-factors and symptoms of stroke or to seek early treatment.

Purpose of the Study

The purpose of this study is to examine the issue of African-Americans and stroke.

Significance of the Study

The significance of this study is the additional knowledge that will be added to the already existing base of knowledge in this area of study.

Methodology

The methodology employed in this study is of a qualitative and interpretive nature and has been conducted through a review of literature in this area of study.

Introduction

According to the National Stroke Association (2010) stroke is "…the third leading cause of death in American and the leading cause of disability." In addition, it is reported that 80% of strokes are preventable." (National Stroke Association, 2010) A stroke or 'brain attack' is reported to occur "…when a blood clot blocks an artery (a blood vessel that carries blood from the heart to the body) or a blood vessel (a tube through which the blood moves through the body) breaks, interrupting blood flow to an area of the brain. When either of these things happen, brain cells begin to die and brain damage occurs." (National Stroke Association, 2010)

Brain cells die during the stroke and the individual loses abilities including those such as speech, movement and memory. (National Stroke Association, 2010) Some individuals who experience a stroke only have minor problems resulting from the stroke however, individuals who have larger strokes may experience paralysis on one side and lose their ability to speak. Some individuals recover completely from having had a stroke however, "more than 2/3 of survivors will have some type of disability." (National Stroke Association, 2010)

Literature Review

African-American adults are reported to be 1.7 times more likely to have a stroke than their white adult counterparts according to the Office of Minority Health (2010). Men are stated to be 60% more likely to die from a stroke than are their White adult counterparts." (Office of Minority Health, 2010) A Centers for Disease Control health interview states findings that "African-Americans stroke survivors are more likely to become disabled and have difficulty with activities of daily living than their non-Hispanic white counterparts." (Office of Minority Health, 2010) The following chart lists age-adjusted percentages of stroke among persons 18 years of age and over.

Figure 1

Age-adjusted Percentages of Stroke Among Persons 18 years of age and over (2007)

Age-adjusted percentages of stroke among persons 18 years of age and over, 2007

African-American

White

African-American/

White Ratio

Men and Women

3.7

2.2

1.7

Men

2.8

2.1

1.3

Women

4.2

2.2

1.9

Source: CDC 2009. Summary Health Statistics for U.S. Adults: 2007. Table 2.

http://www.cdc.gov/nchs/data/series/sr_10/sr10_240.pdf[PDF | 8.43MB]

The following chart lists the death rate from strokes in 2006.

Figure 2

Age-Adjusted Stroke Death Rates per 100,000 cases (2006)

Age-Adjusted Stroke Death Rates per 100,000 (2006)

Non-Hispanic Black

Non-Hispanic White

Non-Hispanic Black/Non-

Hispanic White Ratio

Men

68.4

41.7

1.6

Women

58.0

41.5

1.4

Total

62.8

41.9

1.5

Source: CDC, 2009. National Vital Statistic Report. Vol. 57, Num 14 Table 17.

http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf[PDF | 1.7MB]

The following chart contains data from NHIS from 2001-2001 which was analyzed to examine stroke-related disability.

Figure 3

Age-adjusted Percentage of Stroke Survivors, aged 18 years and over who report difficulty in performing activities 2000-2001

Limitation of Activity

African

Americans

Non-Hispanic

White

African

American/Non-

Hispanic White

Ratio

Walk 1/4 of a mile (3 city blocks)

45.1

36.5

1.2

Walk up 10 steps without resting

42.4

28.6

1.5

Stand or be on your feet for 2 hours

50.2

41.1

1.2

Sit for about 2 hours

16.4

10.7

1.5

Stoop, bend or kneel

44.8

37.7

1.2

Reach up over your head

21.6

14.7

1.5

Use your fingers to grasp or handle...

grocery bag)
40.6

24.6

1.7

Push or pull large objects like a living room chair

45.2

32.5

1.4

Go out to things like shopping, movies, or sporting events

30.1

20.0

1.5

Participate in social activities like visiting friends

23.8

16.2

1.5

Do things to relax at home (reading, watching TV, sewing)

9.6

5.4

1.8

Source: CDC 2005. Differences in Disability Among Black and White Stroke Survivors -- United States, 2000-2001. MMWR 54(1): 3-6.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5401a2.htm

According to statistics, one-half of all African-American women will die from stroke or heart disease. (National Stroke Association, 2010) African-Americans are reported to be twice as likely to die from strokes as White Americans as the rate of first stroke in African-Americans is reported to be "almost double that of Caucasians, and strokes tend to occur earlier in life for African-Americans than Caucasians." (National Stroke Association, 2010) African-Americans are more affected by stroke than any other racial group in the U.S. population and it is reported that it is not clear why that this is true although there are identified factors that play a primary role including that African-Americans have a higher rate of the following:

(1) High blood pressure which is the number one risk factor for stroke. One of every three African-American suffer from high blood pressure;

(2) Diabetes -- also increases the risk for stroke;

(3) Sickle cell anemia -- the most common genetic disorder among African-Americans. Sickle shaped cells often block a blood vessel to the brain causing stroke;

(4) Smoking -- doubles the risk for stroke; and (5) Obesity. (National Stroke Association, 2010)

For the individual with one of more of these risk factors it becomes "…even more important to learn about stroke symptoms and response and the lifestyle and medical changes that can be made to prevent a stroke." (Office of Minority Health, 2010) Interesting facts stated by the Office of Minority Health include the following facts: (1) African-Americans have twice the mortality from stroke compared with Caucasians; (2) African-Americans have more severe and disabling strokes compared with Caucasians; (3) African-American women have a lower 1-year survival following ischemic stroke (caused by a blood clot) compared with Caucasians; (4) African-Americans have twice the risk of first ever strokes compared with Caucasians; (5) Among those aged 20 to 44 years of age, African-Americans are 2.4 times more likely to have a stroke compared with Caucasians; and (6) African-Americans are significantly less likely to receive tPA, the only FDA-approved treatment for stroke, compared with Caucasians." (Office of Minority Health, 2010) According to Neipris (1998) the following may help the African-American individual avoid the experience of having a stroke:

(1) Have your blood pressure checked as often as your doctor suggests. The most important risk factor for stroke is high blood pressure. It's called the "silent killer" because there are no symptoms. About one in three African-Americans (both men and women) has high blood pressure. If you have high blood pressure, you may need to take medicine to keep your blood pressure under control.

(2) Know your cholesterol numbers. Ask your doctor about a cholesterol blood test. If your cholesterol numbers are borderline or high risk, work with your doctor to lower your risk of heart disease and stroke.

(3) Eat right to reduce stroke risk. Just keep a few points in mind:

(a) Reduce sodium (salt). Avoid canned foods, where sodium content is often high. Avoid lunch meats that are high in sodium. (b)Reduce cholesterol. Go for lean meats, such as chicken and fish. Trim skin and fat from chicken. (c) Reduce your calories. This is important if you are trying to reach a healthy weight. Limit portion sizes. Look at the calorie amounts of foods by reading the label. (d) Increase fiber. Go for high-fiber foods, such as whole-grain breads. Have beans, a great source of lean protein as well as fiber. (e) Have plenty of fruits and vegetables. (f) Don't fry. Instead, prepare foods by baking, broiling and steaming.

4) Quit smoking if you smoke. Smoking not only raises your risk for heart attack and lung cancer. It also doubles your risk for stroke. Get smoking cessation advice from your doctor. Remember, your stroke risk starts to drop the moment you quit.

5) Be active - exercise! Chose an activity you enjoy that keeps up your heart rate, like jogging, cycling or even taking a brisk walk. Regular exercise helps you to reach and maintain a healthy weight. Adults should do moderate to intense exercise for at least 30 minutes on most days of the week. Talk to your doctor before you start to exercise or ramp up your exercise routine.

6) If you drink alcohol, drink only in moderation. Drinking an average of more than one alcohol-containing drink a day (for women) or more than two drinks a day (for men) raises blood pressure, which is a stroke risk. Drinks with alcohol, especially beer, are also a source of empty (non-nutritional) calories, which can lead to overweight/obesity. (Neipris, 1998)

Gorelick (1998) reports that excess mortality is "a pervasive theme in the African-American community. African-Americans are more likely to die of more chronic diseases, occupational injuries, homicides and violent crimes and have more disproportionate infant mortality." The…