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Abstract
Background and Objectives In the United States, Black, Hispanic, and Asian Americans experience excessively high incidence rates of hemorrhagic stroke compared with White Americans. Women experience higher rates of subarachnoid hemorrhage than men. Previous reviews detailing racial, ethnic, and sex disparities in stroke have focused on ischemic stroke. We performed a scoping review of disparities in the diagnosis and management of hemorrhagic stroke in the United States to identify areas of disparities, research gaps, and evidence to inform efforts aimed at health equity.
Methods We included studies published after 2010 that assessed racial and ethnic or sex disparities in the diagnosis or management of patients aged 18 years or older in the United States with a primary diagnosis of spontaneous intracerebral hemorrhage or aneurysmal subarachnoid hemorrhage. We did not include studies assessing disparities in incidence, risks, or mortality and functional outcomes of hemorrhagic stroke.
Results After reviewing 6,161 abstracts and 441 full texts, 59 studies met our inclusion criteria. Four themes emerged. First, few data address disparities in acute hemorrhagic stroke. Second, racial and ethnic disparities in blood pressure control after intracerebral hemorrhage exist and likely contribute to disparities in recurrence rates. Third, racial and ethnic differences in end-of-life care exist, but further work is required to understand whether these differences represent true disparities in care. Fourth, very few studies specifically address sex disparities in hemorrhagic stroke care.
Discussion Further efforts are necessary to delineate and correct racial, ethnic, and sex disparities in the diagnosis and management of hemorrhagic stroke.
Glossary
- AHA=
- American Heart Association;
- ASA=
- American Stroke Association;
- DNR=
- do not resuscitate;
- ED=
- emergency department;
- ERICH=
- Ethnic/Racial Variations of Intracerebral Hemorrhage;
- EVD=
- external ventricular drain;
- GWTG-S=
- Get With The Guidelines–Stroke;
- ICH=
- intracerebral hemorrhage;
- ICP=
- intracranial pressure;
- IVH=
- intraventricular hemorrhage;
- NIS=
- Nationwide Inpatient Study;
- PEG=
- percutaneous endoscopic gastrostomy;
- SAH=
- subarachnoid hemorrhage
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
CME Course: NPub.org/cmelist
- Received September 13, 2022.
- Accepted in final form March 28, 2023.
- © 2023 American Academy of Neurology
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