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Thompson SG, Barber PA, Gommans JH, Cadilhac DA, Davis A, Fink JN, Harwood M, Levack W, McNaughton H, Feigin VL, Abernethy V, Girvan J, Denison H, Corbin M, Wilson A, Douwes J, Ranta A. The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 20:100358. [PMID: 35036976 PMCID: PMC8743211 DOI: 10.1016/j.lanwpc.2021.100358] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Ethnic inequities in stroke care access have been reported internationally but the impact on outcomes remains unclear. In New Zealand, data on ethnic stroke inequities and resultant effects on outcomes are generally limited and conflicting. Methods In a prospective, nationwide, multi-centre observational study, we recruited consecutive adult patients with confirmed stroke from 28 hospitals between 1 May and 31 October 2018. Patient outcomes: favourable functional outcomes (modified Rankin Scale 0-2); quality of life (EQ-5D-3L); stroke/vascular events; and death at three, six and 12 months. Process measures: access to reperfusion therapies, stroke-units, investigations, secondary prevention, rehabilitation. Multivariate regression analyses assessed associations between ethnicity and outcomes and process measures. Findings The cohort comprised 2,379 patients (median age 78 (IQR 66-85); 51·2% male; 76·7% European, 11·5% Māori, 4·8% Pacific peoples, 4·8% Asian). Non-Europeans were younger, had more risk factors, had reduced access to acute stroke units (aOR=0·78, 95%CI, 0·60-0·97), and were less likely to receive a swallow screen within 24 hours of arrival (aOR=0·72, 0·53-0·99) or MRI imaging (OR=0·66, 0·52-0·85). Māori were less frequently prescribed anticoagulants (OR=0·68, 0·47-0·98). Pacific peoples received greater risk factor counselling. Fewer non-Europeans had a favourable mRS score at three (aOR=0·67, 0·47-0·96), six (aOR=0·63, 0·40-0·98) and 12 months (aOR=0·56, 0·36-0·88), and more Māori had died by 12 months (aOR=1·76, 1·07-2·89). Interpretation Non-Europeans, especially Māori, had poorer access to key stroke interventions and experience poorer outcomes. Further optimisation of stroke care targeting high-priority populations are needed to achieve equity. Funding New Zealand Health Research Council (HRC17/037).
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Affiliation(s)
- Stephanie G Thompson
- Department of Medicine, University of Otago, PO Box 7343, Wellington 6242, New Zealand
| | - P Alan Barber
- University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - John H Gommans
- Hawke's Bay District Health Board, Private Bag 9014, Hastings 4156, New Zealand
| | | | - Alan Davis
- Whangarei Hospital, Maunu Road, Private Bag 9742, Whangarei 0148, New Zealand
| | - John N Fink
- Canterbury District Health Board, PO Box 1600, Christchurch 8140, New Zealand
| | - Matire Harwood
- University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - William Levack
- University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand
| | - Harry McNaughton
- Medical Research Institute of New Zealand, Private Bay 7902, Wellington 6242, New Zealand
| | - Valery L Feigin
- Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Virginia Abernethy
- Stroke Foundation New Zealand, PO Box 12482, Wellington 6144, New Zealand
| | | | - Hayley Denison
- Research Centre for Hauora and Heath, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Marine Corbin
- Research Centre for Hauora and Heath, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Andrew Wilson
- Wairau Hospital, PO Box 46, Hospital Road, Blenheim 7240
| | - Jeroen Douwes
- Research Centre for Hauora and Heath, Massey University, PO Box 756, Wellington 6140, New Zealand
| | - Annemarei Ranta
- Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington 6242, New Zealand
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