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

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dc.citation.volume20
dc.contributor.authorThompson SG
dc.contributor.authorBarber PA
dc.contributor.authorGommans JH
dc.contributor.authorCadilhac DA
dc.contributor.authorDavis A
dc.contributor.authorFink JN
dc.contributor.authorHarwood M
dc.contributor.authorLevack W
dc.contributor.authorMcNaughton H
dc.contributor.authorFeigin VL
dc.contributor.authorAbernethy V
dc.contributor.authorGirvan J
dc.contributor.authorDenison H
dc.contributor.authorCorbin M
dc.contributor.authorWilson A
dc.contributor.authorDouwes J
dc.contributor.authorRanta A
dc.coverage.spatialEngland
dc.date.accessioned2023-06-26T20:14:43Z
dc.date.available2022-03
dc.date.available2023-06-26T20:14:43Z
dc.date.issued2022-03
dc.description(c) The Author/s
dc.description.abstractBACKGROUND: 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% Māori, 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). Māori 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 Māori had died by 12 months (aOR=1·76, 1·07-2·89). INTERPRETATION: Non-Europeans, especially Māori, 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. FUNDING: New Zealand Health Research Council (HRC17/037).
dc.description.publication-statusPublished online
dc.format.extent100358 - ?
dc.identifierhttps://www.ncbi.nlm.nih.gov/pubmed/35036976
dc.identifierS2666-6065(21)00267-4
dc.identifier.citationLancet Reg Health West Pac, 2022, 20 pp. 100358 - ?
dc.identifier.doi10.1016/j.lanwpc.2021.100358
dc.identifier.eissn2666-6065
dc.identifier.elements-id450727
dc.identifier.harvestedMassey_Dark
dc.identifier.urihttps://hdl.handle.net/10179/18344
dc.languageeng
dc.publisherElsevier Ltd
dc.relation.isPartOfLancet Reg Health West Pac
dc.subjectDisparities
dc.subjectEpidemiology
dc.subjectEthnicity
dc.subjectHealth services research
dc.subjectIndigenous
dc.subjectOutcome resarch
dc.subjectStroke
dc.titleThe impact of ethnicity on stroke care access and patient outcomes: a New Zealand nationwide observational study
dc.typeJournal article
pubs.notesNot known
pubs.organisational-group/Massey University
pubs.organisational-group/Massey University/College of Health
pubs.organisational-group/Massey University/College of Health/Research Centre for Hauora and Health
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