Strokes and African-Americans Are Reported Research Paper

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[. . .] 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 following figure lists the comparative life expectancy in the United States of White women and men and Black women and men.

Figure 5

White women

79.6 y

Black women

73.8 y

White men

72.9 y

Black men

64.6 y

Comparative Life Expectancy in the United States

(Gorelick, 1998)

Gorelick (1998) reports that in the U.S. "…excess stroke mortality has been substantial for both African-Americans and whites in the southeastern portion of the country, an area known as the Stroke Belt. Stroke mortality is not uniform in this region. The highest rates appear along the coastal plain of Georgia and the Carolinas in an area dubbed the stroke "buckle." Recent study suggests a shift of the Stroke Belt to the lower Mississippi River Valley." Stroke mortality rates are reported to have recently fallen in this region however it is stated that there "…still remains substantial excess stroke mortality. The reason for this geographically-based excess remains uncertain. (Gorelick, 1998) It has been suggested, according to Gorelick that "…death certificate coding practices, the proportion of African-Americans in the region, regional case fatality, and socioeconomic factors are variables that are unlikely to explain the excess. Cardiovascular, genetic, or environmental factors may explain the disproportion, at least in part, and should be considered the focus of future study in this region." (1998) The following figure lists the stroke incidence rates cited by Gorelick (1998).

Figure 6

Stroke Incidence Rates

Study

Incidence Rate

South Alabama25

208/100-000 blacks1 109/100-000 whites1

Lehigh Valley26

2.43 black:white standard morbidity ratio 4.50 black:white standard morbidity ratio for age <65 y

Northern Manhattan27

567/100-000 black men1 351/100-000 white men1 716/100-000 black women1 326/100-000 white women1

Greater Cincinnati / Northern Kentucky28

288/100-000 African-Americans (first-ever stroke) 2 and 411/100-000 African-Americans (first-ever and recurrent stroke) 2 vs. 179/100-000 whites (first-ever stroke in Rochester, MN) 2

Northern Manhattan29

233/100-000 blacks1 93/100-000 whites1

1 Age-adjusted rates;

2 age- and sex-adjusted rates.

(Source: Gorelick, 1998)

Gorelick writes that there is a "paucity of recent studies of stroke prevalence" and states that African-Americans have a higher incidence of cerebral infarction, subarachnoid hemorrhage, and intracerebral hemorrhage.' (1998) Gorelick notes that these rates "…are generally disproportionately higher for African-Americans at relatively younger ages." (1998) It is reported that Broderick and colleagues "…showed that African-Americans who were up to 75 years had about twice the risk of subarachnoid hemorrhage and 2.3 times the risk of intracerebral hemorrhage when compared with whites. For African-Americans over 75 years of age, however, the odds ratio for intracerebral hemorrhage was only 0.23." (Gorelick, 1998)

It is reported that in the Kaiser Permanente study, "…the risk of hospitalization for subarachnoid hemorrhage was about 2.5 times higher and that of intracerebral hemorrhage 2.3 times higher for African-Americans than whites." (Gorelick, 1998) Gorelick also states that Ischemic stroke subtypes differ by race in that "African-Americans may be at higher risk for lacunar infarction and large-artery intracranial occlusive disease, whereas whites may be more prone to cerebral embolism, transient ischemic attack, and possibly extracranial occlusive disease. Debate has occurred concerning the possible racial propensity for intracranial or extracranial occlusive disease. Data to support the belief that racial differences exist in the anatomic distribution of occlusive cerebral vascular disease originate from a variety of types of studies such as autopsy, angiography, noninvasive blood flow, and clinical trials. Much of this data, however, emanates from referral centers or select populations that may not be representative of the community at large. Thus, it may be premature to conclude that there are clear-cut racial differences in the distribution of occlusive cerebral vascular disease. The weight of the available data suggests that African-Americans are more likely to have symptomatic intracranial occlusive disease, whereas the results are mixed with regard to a racial propensity for symptomatic or asymptomatic extracranial occlusive disease. Several studies suggest that intimal-medial thickness may be greater at some asymptomatic extracranial sites in African-Americans but at other sites in whites." (Gorelick, 1998) Gorelick reports that the exact reason for "…racial differences in the frequency of stroke subtype and the possible differences in the anatomic distribution of occulusive cerebral vascular disease is not known." (1998) However, Gorelick states that the presumption has been made that it is due to "differences in the frequency, severity and control of major cardiovascular risk factors such as hypertension." (1998)

The explanations that have been proposed for the reason that there is excess stroke mortality and risk in African-Americans include those as follows: (1) higher prevalence of cardiovascular risk factors; (2) greater severity of risk factors or greater sensitivity to the risk factors; and (3) lack of access to care. (Gorelick, 1998) As traditional cardiovascular disease risk factors including hypertension and diabetes mellitus do not account for the disproportionate burden of stroke in the African-American population other conventional factors may play a role including socioeconomic status (SES).

Measures that are commonly used include: (1) education; (2) income; (3) occupation; (3) employment status; (4) indexes of social class; (5) measures of living conditions; (6) area-based measures; (7) life-span measures; and (8) measures of income inequality. (Gorelick, 1998) Primary measures of SES are stated to include: (1) education; (2) occupation; and (3) income. (Gorelick, 19989) SES is stated to have been a predictor of "all-cause mortality or coronary disease mortality." (Gorelick, 1998) African-Americans have been historically underrepresented in clinical trials however, the U.S. government is reported to have set mandates in diversity in the conduction of population studies and the National Institute of Health has recruited women and minorities for such studies. The following shows the representation of African-American in stroke trials.

Figure 7

Representation of African-Americans in Stroke Trials

Study

Total Patients, n

% Black

Ticlopidine Aspirin Stroke Study111 (1989)

16

Canadian American Ticlopidine Study112 (1989)

28

North American Symptomatic Carotid Endarterctomy Trial (70 -- 90% stenosis group) 113 (1991)

3

NINDS rt-PA Study114 (1995)

27

Asymptomatic Carotid Atherosclerosis Study115(1995)

2

Clopidogrel vs. Aspirin in Patients at Risk of Ischemic Events (CAPRIE)116 (1996)

6431 (Stroke subgroup)

9

African-American Antiplatelet Stroke Prevention Study (AAASPS)117 (ongoing, as of 10/19/98)

Source: Gorelick (1998)

It was reported in the work entitled "African-American Have Highest Stroke Rate, Southerners More Likely to Die" that African-Americans age 65 and younger "are more than twice as likely to have a stroke compared with Caucasians in any region, and people who have a stroke are more likely to die in the South than elsewhere, according to researcher at the University of Alabama at Birmingham (UAB) School of Public Health." (Science Daily, 2010) The findings are from UAB's 'Reasons for Geographic and Racial Differences in Stroke' (REGARDS) study that included in excess of 30,200 participants in the United States. The report is stated to be "among the first to show major regional and racial disparities in stroke rates." (Science Daily, 2010)

A report published March 1st, 2010 reports that findings of a meeting of the American Stroke Association (ASA) stated the following:

(1) Among people aged 45 to 54, there were 192 strokes per 100,000 African-Americans vs. 74 strokes per 100,000 whites.

(2) Among people aged 55 to 64, there were 387 strokes per 100,000 African-Americans vs. 204 strokes per 100,000 whites.

(3) Among people aged 65 to 74, there were 713 strokes per 100,000 African-Americans vs. 439 strokes per 100,000 whites.

(4) Among people aged 75 to 84, there were 1,095 strokes per 100,000 African-Americans vs. 925 strokes per 100,000 whites. (Laino, 2010)

Laino (2010) additionally reports that African-Americans were found to be "less likely to have regular follow-up exams for management of risk factors."

In a study conducted and reported by Howard, et al. (2006) findings show that "across age and sex strata, the black-to-white stroke mortality ratio was consistently higher for southern states with an average black-to-white stroke mortality ratio that range from 6% to 21% higher among southern states that in nonsouthern states." (Howard, et al., 2006)

The work entitled "Reducing Stroke Risk in African-Americans" reports that African-American children who have siblings with sickle cell disease (SCD) are more likely to have "abnormal, 'twisted' arteries in the brain, which may lead to an elevated risk of stroke in adulthood." (St. Jude Children's Research Hospital, 2003) It is reported that these arteries are similar to those common viewed in older patients with hypertension however… [END OF PREVIEW]

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