What's scarier than having a stroke? Having one and not receiving proper treatment. It's nice to think that medicine is unbiased, but according to the American Academy of Neurology (AAN), women and people of color may be undertreated for stroke symptoms compared to other demographics. You know, because the thought of having a stroke wasn't alarming enough on its own.
In a study published online in the journal Neurology, researchers analyzed eight years of data from more than 61,500 patients across the country who arrived at a hospital within two hours of presenting ischemic stroke symptoms. The best-regarded treatment for ischemic stroke is intravenous tissue plasminogen activator (tPA), but researchers found that on average, a quarter of patients weren't given tPA within three hours of checking in, despite being eligible for the treatment. Fortunately, this trend decreased over time, from 55 percent of patients between 2003 and 2005 to 18 percent in 2010 to 2011 — but the fact remains that a significant chunk of patients weren't receiving a potentially lifesaving treatment on time.
When researchers adjusted for factors like stroke severity, they found that certain characteristics were associated with failure to treat. The list was fairly long — it included things like age, stroke severity, and hospital location — but two factors stood out: According to the study, patients were less likely to be treated for ischemic stroke if they were women or nonwhite.
Researchers found that women were eight percent more likely to go without tPA, and the odds were worse for people of color. Black patients had a 26 percent higher chance of going untreated than white patients, and other nonwhite ethnicities weren't far behind, with a 17 percent higher chance. Although the odds of receiving treatment have improved over time, "some groups, including older patients, milder strokes, women, and minorities, may be undertreated," researchers concluded.
This is unsettling for a number of reasons — chief among them, the fact that women and people of color are more likely to have a stroke in the first place. According to the National Stroke Association, 55,000 more women have a stroke each year than men, and they're more likely to die as a result. Strokes are the third leading cause of death for women in the United States, but they're the fifth leading cause of death for men. Furthermore, the Centers for Disease Control reports that American Indians, Alaska Natives, and African Americans are more likely to have a stroke than other ethnicities. In particular, someone who is black is nearly twice as likely to have a first stroke as a white person, and they're more likely to die from a stroke overall.
So why aren't women and people of color getting treated? It's a complicated question, and the researchers for the stroke study didn't attempt to offer any explanations. However, this isn't the first time the medical community was criticized for handling patients differently. Research has shown that women's pain is taken less seriously than men's until they can "prove" they're ill — an attitude that has tangible results in the way female patients are treated as a whole. The situation is just as grim for people of color: In 2002, a report found that patients who identify as a minority tend to receive lower-quality healthcare than white patients, even adjusting for factors like income and insurance coverage. More recently, a 2015 report found that black and Hispanic women were more likely to receive a breast cancer diagnosis at a later stage, and a report published by the American Psychological Association that same year found that people of color receive poore mental healthcare than white people.
Unfortunately, there isn't much patients can do to combat this difference in treatment; that's up to the medical community. On the other hand, the study did find that stroke treatment is improving over time — let's hope the trend continues.