Cerebrovascular health disparities.

In the United States, those at highest risk for stroke are the least aware of it. White and coauthors of the Northern Manhattan project in an article published in Circulation1 report that the annual age adjusted incidence of first ischemic stroke per 100 000 was 88 in whites, 149 in Hispanics and 191 in blacks. And yet, among Hispanic women, only 29% identified sudden weakness or numbness on one side of the body as a warning sign. Thirty-two percent of black women and 39% of white woman did. Seventy-nine percent of Hispanic, 84% of black, and 92% of white women knew about clot-busting drugs for stroke if the patient arrived in hospital soon after the symptoms.2 These 2 articles on stroke were part of a special issue of Circulation which focused on cardiovascular health disparities. Conclusions from the articles include the fact that minorities, the poor and the uneducated bear the burden of cardiovascular health disparities, that cardiologists underestimate racial and ethnic disparities in care, and that blacks are less likely to get expensive, newer heart treatments. A particularly troubling finding relates to the implementation of health report cards. Designed to improve the quality of health, they have had the unintended consequence of reducing the proportion of minorities who are offered coronary artery bypass grafting surgery. Presumably with the introduction of health report cards surgeons tend to select lower-risk patients and those most likely to follow a treatment regime. Minorities are disadvantaged in terms of access to health care and the ability to follow through on treatments that require regular follow up. The cardiovascular health disparities theme issue also includes a commitment by the American Heart Association to reduce coronary heart disease and stroke risk by 25% by 2010 and to narrow the cardiovascular and cerebrovascular health disparities. George Mensah, acting director of the National Center for Chronic Disease Prevention and Health Promotion at the Centers of Disease Control paraphrases Dr. Martin Luther King: “poor quality health care anywhere is a threat to quality care for all Americans everywhere.” The health of a nation is indivisible.