Thursday, March 11, 2021

Life-saving role of mobile stroke units at risk due to reimbursement limitations

American Stroke Association International Stroke Conference -- presentation MP19

AMERICAN HEART ASSOCIATION

Research News

DALLAS, March 11, 2021 -- Ambulances with specialized staff and equipment to provide rapid stroke treatment report financial difficulties due to limited reimbursement from health care insurers, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the most recent comprehensive data from the Centers for Disease Control and Prevention (CDC), stroke is the fifth leading cause of death in the United States and a major contributor to long-term disability. Stroke occurs when a blood vessel to or in the brain either becomes blocked or bursts, preventing blood and oxygen from reaching all of the brain. Treatment to quickly restore blood flow to the brain is essential to improve outcomes and survival.

Mobile stroke units are ambulances with specialized staff and equipment to quickly diagnose and treat stroke on the way to the hospital. When every minute is critical, the mobile stroke unit staff can administer medications to restore blood flow, control bleeding or lower high blood pressure before reaching the emergency department. However, mobile stroke units are not widely available, in part because there are no established means for the government or insurance companies to reimburse the costs of care provided by mobile stroke units, especially when specialized tests (CT scans, etc.) and medications are administered outside of a hospital.

"If mobile stroke units cannot be reimbursed for the important care they provide, this vital service will be lost unless private donors are willing to continually step up to support these programs," said study lead author Kenneth Reichenbach, M.S.N., F.N.P.-C., A.G.A.C.N.P.-B.C., B.S.R.T.-(R), PHRN, program director of the Mobile Stroke Unit at Lehigh Valley Health Network in Allentown, Pennsylvania. "We need overwhelming, united support for this to change within federal entities including the Centers for Medicare and Medicaid Services to explore appropriate pathways for Medicare reimbursement for the full range of advanced mobile stroke unit services."

Through a blinded survey, researchers collected information in June 2019 (to reflect the previous 12 months of their operation) from all 20 U.S. mobile stroke unit programs. Of the 19 units that responded, 18 reported negative financial status while one, classified as an outpatient clinic and not an ambulance, reported a positive financial status. All mobile stroke programs depend at least partly on funding from personal gifts, grants or institutional support because of billing restrictions from health care insurers.

In other findings, the programs reported administering critical clot-busting medications to stroke patients an average of 72 times per year (median of 30) over the 12 months surveyed for all mobile stroke unit programs combined. Each program is open and available nearly every day of the month, with 600 responses per year, on average, for all programs combined. All mobile stroke units can perform CT scans (computed tomography) to image the brain, and 21% have an additional certification as certified CT mobile laboratories. Each mobile stroke unit has an average of four staff members on board at a time, which may include a CT technologist, paramedic/emergency medical technician, stroke nurse and a stroke expert. Individuals working as stroke experts vary by program: 37% have medical doctors and 16% have an advanced practice health care professional. In 47% of the programs, telemedicine is used instead of an on-board expert to connect remotely to a stroke expert.

"Mobile stroke units diagnose and treat patients with acute stroke safely and considerably faster than patients arriving to an emergency department by regular ambulance or private auto," Reichenbach said. "Saving brain tissue could translate into better functional outcome and quality of life for many more stroke patients."

The American Heart Association's 2019 Recommendations for the Establishment of Stroke Systems of Care suggests reimbursement is an issue that warrants further investigation before there is widespread use of mobile stroke units.

To recognize stroke symptoms requiring immediate treatment, the American Stroke Association recommends everyone remember the acronym F.A.S.T. for face drooping, arm weakness, speech difficulty, time to call 9-1-1. Fortunately, most strokes are preventable through healthy lifestyle choices: not smoking; eating healthy foods; being physically active; maintaining a healthy body weight; and controlling high blood sugar, cholesterol and blood pressure.

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Co-authors are Claranne Mathiesen, R.N., M.S.N., C.N.R.N.; Leslie Thomas, A.A.; Margaret Hilger, B.A.; James C. Grotta, M.D.; and Anne W. Alexandrov, Ph.D., R.N. Author disclosures are listed in the abstract.

The Prehospital Stroke Treatment Organization (PRESTO) funded the study.

Additional Resources:

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

The American Stroke Association's International Stroke Conference (ISC) is the world's premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. This 3-day conference features more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke -- the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.

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African American women experience higher risk of pregnancy-related stroke, death

American Stroke Association International Stroke Conference - Presentation P869

AMERICAN HEART ASSOCIATION

Research News

DALLAS, March 11, 2021 -- African American women have a significantly increased risk of stroke and death during pregnancy and childbirth or in the period right after birth, compared to the risk of stroke among white women, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

"Each year, thousands of American women have a stroke or die from a stroke during pregnancy. The risk of stroke is also high following childbirth," said lead study author Mohamed M. Gad, M.D., a resident physician in the department of internal medicine at the Cleveland Clinic in Cleveland, Ohio. "Even so, we lack data on the racial disparities in cardiovascular disease and stroke outcomes for women during and post-pregnancy in the U.S."

Using the Nationwide Inpatient Sample, a hospital database across the U.S., researchers analyzed data on nearly 40 million pregnant and post-partum women hospitalized during pregnancy regardless of cause between 2002 and 2017. Nearly 22% of the women included were African American.

Researchers evaluated stroke outcomes among the pregnant women and found:

  • While pregnancy-related stroke was very rare, occurring in just 0.03% of the overall study population, 41% of the women who experienced a stroke during pregnancy were African American.
  • The highest number of in-hospital deaths for women with pregnancy-associated stroke occurred among African American women, 7.8% versus 5% for white women.
  • Compared with white women, African American women with pregnancy-associated stroke faced nearly two times the risk of dying from stroke, and the increased risk of death was consistent across age groups. There was little change in these results after accounting for multiple risk factors.
  • When comparing pregnancy-associated stroke outcomes by income levels, African American women in the lowest income group were 1.91 times more likely to die than white women in the same income group. In the highest income group, African American women were 2.38 times more likely to die compared to their white counterparts.

"We found that serious disparities exist despite adjusting for socioeconomic variables. This means that there is no single socioeconomic factor such as income or access to health care that puts a woman more at-risk. Those factors can contribute, yet they do not explain the whole story," Gad said. "We need to understand and address other potential causes of pregnancy-associated stroke and death. If addressed, we can lower the overall burden of disease in the U.S."

Gad said the study provides evidence that can help improve understanding and guide interventions that could help minimize these racial gaps.

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Study co-authors are Jasmin Abdeldayem, M.D.; Omar M. Abdelfattah, M.D.; Anas M. Saad, M.D.; Ahmed M. Mahmoud, M.D.; and Islam Y. Elgendy, M.D. The authors' disclosures are listed in the abstract. The study authors report no funding.

Additional Resources:

Multimedia is available on the right column of release link https://newsroom.heart.org/news/african-american-women-experience-higher-risk-of-pregnancy-related-stroke-death?preview=dba8212524afb87cd55a3b044b20c844

U.S.-born Black women at higher risk of preeclampsia than Black immigrants
Pregnancy-related stroke more common among Black women
Why are Black women at such high risk of dying from pregnancy complications?
How to have a heart-healthy pregnancy before you even conceive

For more news at ASA International Stroke Conference 2021, follow us on Twitter @HeartNews #ISC21.

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

The American Stroke Association's International Stroke Conference (ISC) is the world's premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. The 3-day conference will feature more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke -- the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.


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Structural racism: Communities with higher redlining scores had higher rates of stroke

American Stroke Association International Stroke Conference -- presentation P873

AMERICAN HEART ASSOCIATION

Research News

DALLAS, March 11, 2021 -- Discriminatory housing policies that restricted the sale or purchase of homes by race in certain neighborhoods across the U.S., called 'redlining,' which were established nearly a century ago and outlawed by the Fair Housing Act of 1968, were associated with higher rates of stroke in the same neighborhoods in 2017, according to preliminary research to be presented at the American Stroke Association's International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

"Differences in stroke rates, whether we are studying ischemic or hemorrhagic stroke, are usually attributed to biological differences or differences in underlying conditions," said lead study author Jeffrey J. Wing, Ph.D., M.P.H., an assistant professor of epidemiology in the College of Public Health at The Ohio State University in Columbus, Ohio. "Yet, our findings suggest the difference we found in the Columbus area may actually be the result of structural racism."

Beginning in 1936, the Home Owners' Loan Corporation began restricting the sale of homes in certain neighborhoods across the country by redlining or marking neighborhoods by "risk for investment," which equated to race. As a result, residents who lived within these redlined areas were denied home loans, which lowered tax revenues in these communities, thereby reducing investment in schools and services, and creating numerous inequities for residents for multiple generations.

"Even though redlining was abolished in 1968, redlining is a form of structural racism that perpetuated segregation and racial inequities. Accumulating evidence shows this divisive and exclusionary housing practice continues to have long-term effects on the health of many people, even today - more than 80 years later," said study co-author Helen Meier, Ph.D., M.P.H., assistant research scientist at University of Michigan's Institute for Social Research. "Our study is one of the first to link historic redlining in a U.S. city to frequency of stroke."

Researchers examined the association between the discriminatory housing policies of redlining and stroke rates in Columbus, Ohio neighborhoods in 2017. They calculated historic redlining scores for neighborhoods within the boundaries of Columbus based on the degree of redlining. Thus, the greater the redlining, the higher the redlining score.

Researchers then matched the redlining scores with stroke rates measured in the same neighborhoods from the 500 Cities Project. The 500 Cities Project is from the U.S. Centers for Disease Control and Prevention and reports on 27 chronic disease measures for the 500 largest American cities in all 50 states, quantified by city and census tract-level data. They assessed the association between historic redlining scores and stroke rates across neighborhoods in Columbus in 2017.

Researchers found:

  • Higher historic redlining scores were associated with greater rates of stroke, when comparing the highest to the lowest quartile of historic redlining scores. 
  • Neighborhoods in the highest group of historic redlining scores had a 1.48% higher stroke rate, compared to those with the lowest redlining scores.

"As different cities across the country declare racism as a public health crisis, it's important to have more research that shows the link between racism and health disparities," Wing said. "Our research has the potential to help change how we treat and care for all individuals and promote equitable access to care that can lead to improved health outcomes."

"Health disparities in stroke are going to persist until we address the legacy of structural racism, of which historical redlining is one form," Meier said. "It's important to document the significant, negative impacts of structural racism on health."

Study limitations include people who had a history of stroke may not have always resided in the same census tract, leading to unmeasured variability in redlining exposure. In addition, this is an ecologic-designed study, where redlining exposure was combined with stroke rate to a neighborhood level, which limits the assessment of individual associations, Wing added.

The American Heart Association recently published a presidential advisory that names structural racism as a cause of poor health and premature death from heart disease and stroke. The advisory, titled "Call to Action: Structural Racism as a Fundamental Driver of Health Disparities," reviews the historical context, current state and potential solutions to address structural racism in the U.S. and outlines steps the Association is taking to address and mitigate the root causes of health care disparities.

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Co-authors of the study are Emily E. Lynch, M.P.H.; Sarah E. Laurent, Ph.D. candidate; Bruce C. Mitchell, Ph.D.; and Jason Richardson, M.A. The authors' disclosures are listed in the abstract.

Meier's work was funded in part by the Shaw Scientist Award from the Greater Milwaukee Foundation. Wing reports no study funding.

Additional Resources:

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.


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Long-term stroke death rates are higher among Black Medicare patients

American Stroke Association International Stroke Conference -- presentation P655

AMERICAN HEART ASSOCIATION

Research News

DALLAS, March 11, 2021 — A long-term look at Medicare patients shows that Black patients who have an ischemic stroke (blocked blood flow to the brain) die at a higher rate than white patients, even after accounting for preexisting health conditions, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

“So much of what we know is limited to the early or acute phase — the first two weeks after a stroke,” said lead study author Judith H. Lichtman, Ph.D., M.P.H., professor and chair of the department of epidemiology at the Yale School of Public Health in New Haven, Connecticut. “When you have a stroke, it’s not just about the acute event, it’s about the early recovery period to secondary prevention visits that affect your long-term chances of survival.”

Researchers analyzed data on 744,044 Medicare beneficiaries (ages 65 and older) who had been treated at U.S. hospitals for ischemic stroke between 2005 and 2007. Overall, 85.6% were white, 9.9% were Black and 4.5% were of other races or ethnic groups. Black patients had higher rates of kidney failure, dementia and diabetes. Atherosclerosis and chronic obstructive pulmonary disease (COPD) were more common in white patients.

Patients were followed over a 10-year period, and analysis of the data found:

  • Overall, the death rate was about 75%. Black patients had the highest death rate at 76.4%, followed by whites at 75.4%; and the death rate for those of other races or other ethnic groups was 70.3%.
  • Even after adjusting for differences in preexisting health problems, the risk of death within 10 years after stroke was about 4% higher for Black patients than white patients. However, the stroke death risk was about 8% lower for those of other races.
  • Importantly, within the first year after hospital discharge for ischemic stroke, the death rate for Black patients started to climb slightly in comparison to whites and other races, and these differences continued over the decade.

“These are racial differences in long-term stroke survivorship, and these differences start within the first year after a stroke,” Lichtman said. “We need to take a closer look at the recovery period and think about how we can optimize secondary prevention and post-stroke care for everybody. Stroke care during the first year after a stroke plays an important role in the long run.”

Future research will need to investigate the reasons behind these differences in death rates among Black patients and white patients. “Currently, much of the focus is on the acute stroke event, itself, yet we need to find out more – are there racial differences using rehab services, are some people not seeing neurologists and getting follow up care?” Lichtman said. “Stroke is an acute event, but it’s just as important to focus on early follow-up care that will support patients for better long-term outcomes and survival.”

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Co-authors are Erica C. Leifheit, Ph.D.; Yun Wang, Ph.D.; Andrew Arakaki, M.P.H.; and Larry B. Goldstein, M.D. The authors’ disclosures are available in the abstract.

The study was funded by the American Heart Association and the National Institute on Aging of the National Institutes of Health.

Additional Resources:

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association’s overall financial information is available here.

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. The 3-day conference will feature more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.


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Black and Hispanic workers overrepresented in occupations with higher risk for COVID-19 exposure


Black workers are especially overrepresented in indoor jobs that require close proximity to others, while Hispanic workers are especially overrepresented in high proximity outdoor jobs, researchers report in the American Journal of Preventive Medicine

ELSEVIER

Research News

Ann Arbor, March 11, 2020 - Black and Hispanic people experience a higher risk for COVID-19 and severe illness, influenced by factors such as discrimination, housing, and healthcare access and utilization. Now, a new study in the American Journal of Preventive Medicine, published by Elsevier, identifies specific job categories that put workers at risk because they require working in close contact with others. Some of these jobs have a disproportionately high number of Black or Hispanic workers. The findings should be used to inform workplace interventions to reduce the risk for these particularly vulnerable communities.

"About three-quarters of US workers have jobs either indoors or outdoors that involve contact with other people that is sufficiently close to put them at higher risk for COVID-19," explained co-investigators Jean M. Cox-Ganser, PhD, and Paul K. Henneberger, ScD, both of the Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA. "Our findings provide insight on where to reach the greatest number of workers who are potentially at risk for COVID-19 based on working close to others, including which occupations have larger numbers of minority workers."

Researchers used data from the Occupational Information Network (O*NET) and the Bureau of Labor Statistics (BLS) to classify the occupations of all US workers into six categories for risk of COVID-19 exposure at work: low, medium, or high proximity work indoors; and low, medium, or high proximity work outdoors. They studied the distribution of workers by occupation in the higher risk categories (medium or high proximity indoors and high proximity outdoors) and determined where Black and Hispanic workers were overrepresented.

Information on 772 detailed occupations and 144,525,054 workers was examined. Researchers found that a high proportion of US workers may be at greater risk for exposure to COVID-19 because their occupations involve either high proximity to others indoors or outdoors (25.2 percent, 36.5 million people) or medium proximity work indoors (48.0 percent, 69.6 million workers). A higher proportion of Black workers perform high proximity indoor work compared to all workers (27.5 percent vs 22.1 percent). In contrast, Hispanic workers had higher representation in outdoor work categories: 5.0 percent Hispanic vs 3.1 percent all workers in high proximity outdoor work and 7.0 percent vs 5.3 percent in medium proximity outdoor work.

Black workers were overrepresented in 103 of the 772 occupations. Eighty of those occupations were in the proximity and indoor/outdoor categories at higher risk for exposure and included 34.7 percent of all Black workers. Hispanic workers were overrepresented in 124 of the 772 occupations. Seventy-six of these occupations were in higher risk categories and included 21.5 percent of all Hispanic workers.

The authors highlighted the most populous occupations in each of the three higher risk exposure categories where Black or Hispanic workers were overrepresented. The indoor high proximity occupations for Black workers were Home Health Aides, Nursing Assistants, and Personal Care Aides, while for Hispanic workers they were Restaurant Cooks, Medical Assistants, and Dining Room/Cafeteria Attendants and Bartender Helpers. The outdoor high proximity occupations had many fewer Black than Hispanic workers. In this category large numbers of Hispanic workers were Landscaping and Groundskeeping Workers, Carpenters, and Cement Masons and Concrete Finishers. Looking at indoor medium proximity work, Laborers and Freight, Stock and Material Movers included large numbers of both Black and Hispanic workers. Additionally, large numbers of Black workers were Cashiers and Stock Clerks/Order Fillers, while large numbers of Hispanic workers were Hand Packers/Packagers and Food Preparation workers.

Prevention strategies should consider worksite conditions, and communication messages should be tailored to the languages and preferred media of the workforce.

Although there are recommendations for keeping a distance of at least six feet between people to minimize the spread of SARS-CoV-2, such social distancing may not be possible in indoor and outdoor occupations that require high physical proximity to perform work tasks.

"Efforts to control the spread of the virus that causes COVID-19 are still needed in all aspects of our lives, including at work. Becoming complacent in wearing a mask, physical distancing, and other prevention efforts during the rollout of the vaccine could have unfortunate consequences not only for ourselves, but also for our family members, co-workers, and friends," cautioned Dr. Cox-Ganser and Dr. Henneberger.

"We all have a role to play, including getting the COVID-19 vaccine when it is offered."

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Experiences of Latinx Individuals Hospitalized for COVID-19

A Qualitative Study

Lilia Cervantes, MD1,2,3; Marlene Martin, MD4; Maria G. Frank, MD1,3; et alJulia F. Farfan, BS5; Mark Kearns, MD1,3; Luis A. Rubio, MD4; Allison Tong, PhD6,7; Andrea Matus Gonzalez, BNutrSc6,7; Claudia Camacho, BS1; Adriana Collings, MPH2; William Mundo, MPH3; Neil R. Powe, MD4; Alicia Fernandez, MD4
Author Affiliations Article Information
JAMA Netw Open. 2021;4(3):e210684. doi:10.1001/jamanetworkopen.2021.0684

 March 11, 2021
editorial comment icon 
Editorial
Comment
Key Points

Question  Can experiences of Latinx adults hospitalized with coronavirus disease 2019 (COVID-19) inform improvements to public health and health care?

Findings  In this qualitative study of 60 Latinx adults, participants reported COVID-19 misinformation, felt COVID-19 compounded existing social disadvantage, and risked infection because of the need to work. Participants hesitated to seek hospital care because of immigration and economic concerns.

Meaning  These findings suggest that to contain community spread and reduce unnecessary morbidity, immigration, employment, and economic distress must be addressed through tailored public health messaging and public policy interventions that improve economic conditions.

Abstract

Importance  Latinx individuals, particularly immigrants, are at higher risk than non-Latinx White individuals of contracting and dying from coronavirus disease 2019 (COVID-19). Little is known about Latinx experiences with COVID-19 infection and treatment.

Objective  To describe the experiences of Latinx individuals who were hospitalized with and survived COVID-19.

Design, Setting, and Participants  The qualitative study used semistructured phone interviews of 60 Latinx adults who survived a COVID-19 hospitalization in public hospitals in San Francisco, California, and Denver, Colorado, from March 2020 to July 2020. Transcripts were analyzed using qualitative thematic analysis. Data analysis was conducted from May 2020 to September 2020.

Main Outcomes and Measures  Themes and subthemes that reflected patient experiences.

Results  Sixty people (24 women and 36 men; mean [SD] age, 48 [12] years) participated. All lived in low-income areas, 47 participants (78%) had more than 4 people in the home, and most (44 participants [73%]) were essential workers. Four participants (9%) could work from home, 12 (20%) had paid sick leave, and 21 (35%) lost their job because of COVID-19. We identified 5 themes (and subthemes) with public health and clinical care implications: COVID-19 was a distant and secondary threat (invincibility, misinformation and disbelief, ingrained social norms); COVID-19 was a compounder of disadvantage (fear of unemployment and eviction, lack of safeguards for undocumented immigrants, inability to protect self from COVID-19, and high-density housing); reluctance to seek medical care (worry about health care costs, concerned about ability to access care if uninsured or undocumented, undocumented immigrants fear deportation); health care system interactions (social isolation and change in hospital procedures, appreciation for clinicians and language access, and discharge with insufficient resources or clinical information); and faith and community resiliency (spirituality, Latinx COVID-19 advocates).

Conclusions and Relevance  In interviews, Latinx patients with COVID-19 who survived hospitalization described initial disease misinformation and economic and immigration fears as having driven exposure and delays in presentation. To confront COVID-19 as a compounder of social disadvantage, public health authorities should mitigate COVID-19–related misinformation, immigration fears, and challenges to health care access, as well as create policies that provide work protection and address economic disadvantages.

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Differences found in stroke severity and post-stroke care among Black and Hispanic women

American Stroke Association International Stroke Conference - Presentation 51

AMERICAN HEART ASSOCIATION

Research News

DALLAS, March 11, 2021 -- Black and Hispanic women ages 65-74 years old hospitalized with stroke had more severe strokes than their white counterparts, according to preliminary research to be presented at the American Stroke Association International Stroke Conference 2021. The virtual meeting is March 17-19, 2021 and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Heart Association, Black women have a higher rate of stroke (3.8%) when compared to white women (2.5%) of similar age, which could lead to a higher death rate or worse quality of life.

"The Black and Hispanic female stroke survivors 65-84 years old were younger and had a greater chance of being sent to a skilled nursing or rehabilitation center when compared to older white females who were discharged home after their stroke," said study author Trudy R. Gaillard, Ph.D., R.N., an associate professor at Florida International University's College of Nursing and Health Sciences in Miami, Florida.

Researchers analyzed Get With The Guidelines® Stroke health information in 1,587 female patients who were discharged after a stroke from Baptist Hospital of Miami from April 2014 to March 2019. The female stroke patients were categorized by age group: 65-74 years old (young), 75-84 years old (middle) and 85 years or older (older). The data analyzed included stroke type and severity; other health issues; age; race/ethnicity; and discharge information - whether patients were discharged home, to a skilled nursing center or to a rehabilitation facility. Black women with stroke accounted for about 27% of all patients; while 37.5% were Hispanic and about 35% were white. Among the participants ages 85 years or older hospitalized for stroke, 18.4% were Black women, 36% were Hispanic women and about 40% were white women.

Researchers found:

  • Black and Hispanic women ages 65-74 years old hospitalized with stroke had more severe strokes than white women of the same age group. Nearly 99% of the women had health insurance, although Black women were the most likely to be without health insurance. After controlling for age, race, and stroke severity, Black and Hispanic women in the younger (65-74 years) and middle age (75-84 years) groups had a greater chance of being sent to a skilled nursing or rehabilitation center when compared to white women in the oldest age group (85 years and older).

"Future studies are needed to explore the type of health care facilities that women are discharged to after stroke and to examine the quality of care received," Gaillard said. "This type of study should be done in multiple cities, across care settings, including inpatient rehabilitation facilities, skilled nursing facilities or home with or without home health and outpatient rehabilitation services."

Limitations of the study include that it was done in only one hospital and the researchers did not examine patients' outcomes after discharge.

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Co-authors are Joan Vaccaro, Ph.D.; Amy K. Starosciak, Ph.D.; Starlie Belnap, Ph.D.; and Felipe De Los Rios La Rosa, M.D., FAHA. Author disclosures are in the abstract.

The Nicole Wertheim Innovation Opportunity Endowment Fund of the Nicole Wertheim College of Nursing and Health Science at Florida International University funded this study.

Additional Resources:

Multimedia is available on the right column of release link https://newsroom.heart.org/news/differences-found-in-stroke-severity-and-post-stroke-care-among-black-and-hispanic-women?preview=a487f17d6a8df78d87bbb89cc52490f0

What is brain health?
Women's lifestyle changes, even in middle age, may reduce future stroke risk
Blacks, Hispanics of Caribbean descent have higher stroke risk than white neighbors
Get With The Guidelines Patient Education Materials

For more news at ASA International Stroke Conference 2021, follow us on Twitter @HeartNews #ISC21.

Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers are available here, and the Association's overall financial information is available here.

The American Stroke Association's International Stroke Conference (ISC) is the world's premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2021 will be held virtually, March 17-19, 2021. The 3-day conference features more than 1,200 compelling presentations in 21 categories that emphasize basic, clinical and translational sciences as they evolve toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC21.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke -- the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.

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