Thompson 2022


Year: 2022

Title: The impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study

Country: New Zealand

Age: Adult Only

Sex: All Sexes

Population: Multiple Groups

Care Setting: Inpatient and Outpatient

Clinical Setting: Stroke Imaging

Data Level: National

Data Type: Private Survey

Data Source: Local data

Conclusion: Disparities In All Minority Groups

Health OutComes Reported: Yes

Mitigation: No

Free Text Conclusion: Non-Europeans were less likely to receive MRI imaging, and less likely to achieve functional independence at 3, 6, or 12 months.

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% Mori, 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). Mori 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 Mori had died by 12 months (aOR=1.76, 1.07-2.89). INTERPRETATION: Non-Europeans, especially Mori, 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.