title: Ethnic disparities in stroke: epidemiology, acute care, and postacute outcomes.
abstract: OBJECTIVE
  Evidence for ethnic disparities in stroke incidence, severity, and mortality has continued to mount in recent years. However, the picture for disparities in acute management and rehabilitation remains more ambiguous. The objective of this report is to summarize current evidence from stroke epidemiology and studies focusing on disparities in stroke care and disability, suggesting courses for action.
  
  
  METHODS
  A comprehensive search of current literature on ethnic/racial variation in stroke incidence, mortality, and severity, as well as acute and postacute patient care was performed.
  
  
  RESULTS
  Recent evidence unambiguously reaffirms a greater burden of disease in stroke, greater mortality, and greater severity of strokes for blacks. Evidence for disparities in acute and postacute care is less conclusive, as is the evidence for disparities among other ethnic groups. Evidence for health disparities in stroke care across settings, regions, and the continuum of care varies considerably.
  
  
  CONCLUSIONS
  Minority ethnic groups have higher rates or more severe stroke, but variations in prognosis for clinical outcomes other than mortality remain less certain. There is considerable need for more studies that take into account regional ethnic variations in treatment and outcomes, and for better documentation of stroke outcomes among groups in addition to blacks. Dealing with ethnic disparities in stroke will be served by sustained attention to quality improvement in high-impact areas in stroke care, complemented by initiatives that promote cultural competence.
authors.affiliation: Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, Fla, USA. jstansbu@ufl.edu
authors.forename: James P
authors.initials: JP
authors.lastname: Stansbury
authors.forename: Huanguang
authors.initials: H
authors.lastname: Jia
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Duncan
mesh_terms: D000368:Aged; D003695:Delivery of Health Care; D004635:Emergency Medicine; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007902:Length of Stay; D016239:MEDLINE; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D016017:Odds Ratio; D011379:Prognosis; D011787:Quality of Health Care; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology* / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator