Understanding Stroke and the Social Determinants of Health: A Synopsis of the Connecting the Dots Series

Understanding Stroke and the Social Determinants of Health: A Synopsis of the Connecting the Dots Series

July 18, 2024  |  Blog Post 

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Stroke remains a leading cause of disability in the United States, affecting approximately 795,000 people each year. It disproportionately impacts adults over age 65, African Americans, and those in lower socioeconomic groups.1 To address this issue comprehensively, it is essential to consider not only the medical risk factors but also the social determinants of health that influence stroke outcomes.

It's crucial to recognize stroke symptoms quickly. FAST (Face drooping, Arm weakness, Speech difficulty, Time to call 911) can save lives. When 911 is called, patients with stroke symptoms are taken to a hospital specializing in stroke treatment, bypassing the usual wait times. While recognizing stroke symptoms is imperative at the time of emergency, knowing the risks prior to the stroke event and what steps to take after the event is over are equally as important to regaining quality of life. With an increased risk of dementia post-stroke event, timeliness is needed in response to stroke in order to have a better chance at recovery and return to quality of life. Disseminating this information, particularly in underserved communities, is essential due to community members already being at a higher risk due to socioeconomic status.

In Chicago, a group of physicians and researchers are partnering to address the impact of nutrition post-stroke with the intention of working with communities disproportionately affected by stroke. Nutrition Effects on Brain Outcomes and Recovery in Stroke after Hospitalization (NOURISH) is a study that enrolls individuals aged 55 and older who have experienced a stroke and hospitalization in the Chicagoland area. In Connecting the Dots Video #2, Dr. Neelum Aggarwal and Dr. Christy Tangney, the co-principal investigators, introduce this diet intervention study and describe how it provides home-delivered meals to see if the intervention can slow down changes in the brain and reduce the risk of dementia. The study lasts 2-3 years, with interventionists conducting home visits to monitor diet and memory.

Gender Differences and Racial and Ethnic Disparities

Women generally have worse outcomes from strokes compared to men. Until menopause, women are somewhat protected by estrogen, however, post-menopause, their risk increases significantly.2 Additionally, women often face greater challenges in recovery due to their roles as natural caregivers and are less likely to seek immediate hospital care. Additionally, Dr. Laurel Cherian at Rush University Medical Center in Chicago, emphasizes in video #1 that they see a diverse patient population that highlights significant disparities in stroke risk and outcomes among different racial and ethnic groups. For example, black women have double the stroke risk compared to their white counterparts, and black men are 70% more likely to die from a stroke than their white counterparts. These disparities are often exacerbated by issues related to access to care, insurance coverage, implicit biases in healthcare, and health literacy. Patients in underserved populations frequently face additional barriers, such as distrust of the medical system and lack of resources.

The Role of Nutrition in Stroke Recovery

Nutrition plays a pivotal role in stroke recovery and the prevention of further cognitive decline. Ms. Jennifer Ventrelle, one of the study’s nutritionists, emphasizes this is where the NOURISH program is making great strides in advancing recovery outcomes for patients. There is substantial evidence supporting the role of nutrition in preventing cardiovascular events. The Mediterranean diet, for example, has been shown to reduce the number of strokes by slowing cognitive decline. The first year post-stroke is particularly critical, as the brain is very vulnerable. Lifestyle factors, including diet, can significantly aid in brain repair. It is necessary, however, to make sure the nutrition plans exemplify culturally competent variety in order to ensure ease of adherence to tailored diets.

One major focus of the NOURISH study is to ensure diverse representation. Currently, 60% of participants are African American. However, there is a need for culturally competent tools and resources. Dr. Puja Agarwal stresses that many existing dietary guidelines do not account for cultural differences in diet and are often tailored to higher education levels. Efforts like the NHANES study aim to create more representative groups and identify cultural dietary practices. Nutrition studies often lack diverse representation. Tools and interventions must be adaptable and culturally sensitive to be effective across different ethnic groups. For example, if berries are not a common part of a participant's diet, the beneficial components of berries should be identified, and alternative fruits should be considered.

Recruitment and Community Engagement

Effective recruitment and community engagement are critical in clinical trials, particularly those focusing on underserved groups. Building trust is vital in overcoming resistance within different cultural communities and requires transparency and human connection. Ms. Jameszetta James, a recruitment specialist for the NOURISH study, emphasizes the importance of visually representing and authentically engaging with the Black community, while Ms. Amy Tran, also a recruitment specialist, highlights the need for compassion and adaptability in communication. A less scripted conversation and genuine human connection are often most effective in engaging participants. It is essential to understand the community you are trying to connect with and adapt your approach based on social and nonverbal cues.

Understanding and addressing the social determinants of health is vital in reducing stroke risk and improving outcomes. Comprehensive care, education, community support, and culturally competent interventions are key to mitigating these risks and ensuring better health for all.

Understanding and addressing the social determinants of health is vital in reducing stroke risk and improving outcomes. Comprehensive care, education, community support, and culturally competent interventions are key to mitigating these risks and ensuring better health for all. By focusing on both medical and social factors, we can create more equitable health outcomes and improve the quality of life for stroke patients.

References:

1. How many people are affected by/at risk for stroke? https://www.nichd.nih.gov/. Published February 1, 2022.

https://www.nichd.nih.gov/health/topics/stroke/conditioninfo/risk#:~:text=Each%20year%2C%20about%20795%2C000%20people,another%20stroke%20within%205%20years.

2.Menopause and cardiovascular risk. www.goredforwomen.org. Published July 14, 2022.

https://www.goredforwomen.org/en/know-your-risk/menopause/menopause-and-cardiovascular-risk

AUTHORS

Monica Turchyn

Healthcare Analyst, Center for Healthcare Innovation