title: Racial/ethnic disparities in access to physician care and medications among US stroke survivors.
abstract: BACKGROUND
  Mexican Americans and non-Hispanic blacks have higher stroke recurrence rates and lower rates of secondary stroke prevention than non-Hispanic whites. As a potential explanation for this disparity, we assessed racial/ethnic differences in access to physician care and medications in a national sample of US stroke survivors.
  
  
  METHODS
  Among all 4,864 stroke survivors aged≥45 years who responded to the National Health Interview Survey years 2000-2006, we compared access to care within the last 12 months by race/ethnicity before and after stratification by age (45-64 years vs ≥65 years). With logistic regression, we adjusted associations between access measures and race/ethnicity for sex, comorbidity, neurologic disability, health status, year, income, and health insurance.
  
  
  RESULTS
  Among stroke survivors aged 45-64 years, Mexican Americans, non-Hispanic blacks, and non-Hispanic whites reported similar rates of no generalist physician visit (approximately 15%) and inability to afford medications (approximately 20%). However, among stroke survivors aged≥65 years, Mexican Americans and blacks, compared with whites, reported greater frequency of no generalist visit (15%, 12%, 8%; p=0.02) and inability to afford medications (20%, 11%, 6%; p<0.001). Mexican Americans and blacks more frequently reported no medical specialist visit (54%, 49%, 40%; p<0.001) than did whites and rates did not differ by age. Full covariate adjustment did not fully explain these racial/ethnic differences.
  
  
  CONCLUSIONS
  Among US stroke survivors at least 65 years old, Mexican Americans and blacks reported worse access to physician care and medications than whites. This reduced access may lead to inadequate risk factor modification and recurrent stroke in these high-risk minority groups.
authors.affiliation: Department of Internal Medicine, College of Medicine, Ohio State University, Columbus, OH, USA. deblevin@med.umich.edu
authors.forename: D A
authors.initials: DA
authors.lastname: Levine
authors.forename: M V
authors.initials: MV
authors.lastname: Neidecker
authors.forename: C I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: S
authors.initials: S
authors.lastname: Karve
authors.forename: L S
authors.initials: LS
authors.lastname: Williams
authors.forename: J J
authors.initials: JJ
authors.lastname: Allison
mesh_terms: D001741:Black or African American; D003430:Cross-Sectional Studies; D003710:Demography; D005006:Ethnicity; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010820:Physicians; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology*; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology