By AMERICAN HEART ASSOCIATION NEWS
Life after a stroke can be marred by significant impairments, with survivors having to relearn how to speak, walk or carry out day-to-day activities such as cooking and getting dressed. That’s why stroke rehabilitation is recommended to aid the recovery of hundreds of thousands of Americans who survive a stroke each year.
But Mexican-Americans may be getting inferior rehab services compared with whites, a recent study suggests. It may explain why that ethnic group is harder hit by stroke’s long-term effects, researchers said.
Among those receiving rehab, 73 percent of white patients got inpatient rehab — a more intensive recovery program — whereas only 30 percent of Mexican-Americans did. Mexican-American patients were much more likely to receive their rehabilitation care at home or outpatient location, the results show.
A big difference between home-based and inpatient care is the time allotted for services, said the study’s lead author Lewis B. Morgenstern, M.D., a professor of neurology and director of the stroke program at the University of Michigan Medical School and School of Public Health.
Home rehab is one hour of services a day compared with at least three hours at an inpatient center, Morgenstern said. Plus, he added, people who get services at inpatient facilities have access to a variety of exercise machines.
But the study doesn’t prove Mexican-American stroke survivors would recover more cognitive and motor skills if they received aggressive rehab, Morgenstern said. Because this was a small preliminary study, “you have to take these results with kind of a grain of salt — or a boulder of salt,” he said.
Finding ways to reduce the burden of stroke and other diseases among Hispanics and Latinos — the largest ethnic minority group in the United States — will be critical. Among Hispanic and Latino Americans, who can be of any race, stroke is the No. 4 cause of death, according to data from the Centers for Disease Control and Prevention. By comparison, stroke is the third-leading cause of death among blacks, Asians and Pacific Islanders. It is the No. 5 cause of death among white Americans and costs the nation about $34 billion a year.
Compared with most of their cultural peers, Mexican-Americans — who by far make up the largest Hispanic ethnic group — tend to be in worse health and have multiple chronic conditions, such as diabetes and high blood pressure, that can increase stroke risk. Mexican-American participants in the Corpus Christi study had higher rates of diabetes, high blood pressure and smoking compared with their white peers.
Neurologist Salvador Cruz-Flores, M.D., was the lead author of a 2011 report that said stroke impacts racial and ethnic groups differently, but there were few studies addressing racial and ethnic differences in rehabilitation. Since the report, stroke researchers have made an effort to identify those differences and understand why they exist, said Cruz-Flores, who was not involved in the new study. But more targeted work is needed to find ways to reduce the disparities, he said.
The takeaway from the recent study for doctors, Cruz-Flores said, is that not all stroke patients have the same access to rehabilitation services.
“[There is] a tendency for minorities — in this case, Hispanics — to have less access to rehabilitation in a hospital, which has implications in terms of recovery,” said Cruz-Flores, chair of neurology at Texas Tech University Health Sciences Center School of Medicine in El Paso.
The message for stroke patients and their families is to work closely with their doctors in choosing the right type of rehabilitative care, Morgenstern said. When it comes to post-stroke care, he said, one size does not fit all.
Morgenstern and his colleagues now plan to dig deeper into the data, such as information about insurance coverage and why, for example, Mexican-Americans received home care.
“More research needs to be done to really be confident that these are real results,” he said.