It was wonderful to see many of you at the 2025 SNACC Annual Meeting held in September in Atlanta, Georgia. Among the many excellent sessions during the meeting was “Bridging the Gap: Stroke, Perioperative Brain Health, and Disparities in Care.” Dr. Matthew Wixson, Associate Professor in the Department of Anesthesiology at the University of Michigan Medical School, presented data on disparities in risk and outcomes for stroke patients. He discussed the significance of social determinants of health in determining patients’ risk for having a stroke and outcomes. As defined by the Office of Disease Prevention and Health Promotion in the U.S. Department of Health and Human Services, “Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”1 Examples include:
• Safe housing, transportation, and neighborhoods
• Education, job opportunities, and income
• Access to nutritious foods and physical activity opportunities
• Discrimination and violence
• Polluted air and water
• Language and literacy skills
Dr. Wixson noted several dramatic statistics during his presentation: the risk of stroke is nearly double for non-Hispanic Blacks versus Whites, and as might be expected higher socioeconomic status (SES) reduces stroke risk. These findings might be related to lower comorbidity burden because of better access to preventative care and medications. Minority women are more likely to have bad outcomes after stroke as compared to other groups. Data show that women are 30% less likely to receive thrombolytics than men after stroke. Access to care in the United States continues to be a major factor for stroke patients with data showing that Black Americans have longer times from onset to stroke symptoms to arrival in the Emergency Department (ED) and that non-White patients are less likely to have door-to-needle times of 60 minutes or less. These issues impact our perioperative patients as well. Patients with prior stroke have an odds ratio of 10 for perioperative neurocognitive disorders as compared to those who have not had a stroke.
Of course, most of the factors contributing to these disparities in stroke rates and patient outcomes are not within the control of us as individuals working within the health care system. Indeed, the Office of Disease Prevention and Health Promotion notes that many of these conditions contributing to health care disparities are “upstream” factors which are not usually related to the direct delivery of health care.1 However, it is critical that we all be aware of these disparities in order to try to mitigate their effects for our patients.
References
1 – Office of Disease Prevention and Health Promotion https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health
