Social determinants influence stroke treatment
How much money someone makes, where they live and what type of insurance they have may all play a role in whether they receive lifesaving medication after a stroke, new research finds.
Released Feb. 28, the preliminary study found that social determinants of health — conditions that can influence health, longevity and well-being — can influence whether patients are given clot-busting drugs, known as thrombolytic therapy, after suffering a stroke.
Researchers looked at data on more than 63,000 people who had experienced an ischemic stroke, which is caused by a blockage of blood flow to the brain. Only about 11% of patients had received clot-busting drugs, and those that did tended to have more advantages, such as higher incomes or education levels, according to the study, which will be presented at the American Academy of Neurology’s annual meeting in April.
While Black Americans have the nation’s highest stroke rates, they were 10% less likely than white patients to receive clot-busting drugs. Hispanic patients were 7% less likely to receive the therapy.
Also missing out on the critical medications were people covered by public health insurance such as Medicare, Medicaid or Veterans Health Administration plans. Compared to those with private insurance, people with public insurance were 23% less likely to be treated with the drugs.
By area of residence, the study found that stroke patients who lived in rural areas were 40% less likely to receive the treatment than those living in urban areas.
Factors such as proximity to care and how quickly a patient is diagnosed may play a role in the findings, researchers acknowledged, as clot-busting drugs need to be given within a few hours after stroke symptoms begin.
About 795,000 of Americans a year experience strokes, about 87% of which are ischemic. Black Americans have almost two times the risk of white people of having a first stroke and are more likely to die from them.
Effects of disasters linger for older adults
Older adults in the U.S. are increasingly endangered by extreme weather events, which are becoming stronger and more common with climate change.
Not only do health emergencies among seniors increase immediately after a severe disaster, deaths among the population stay elevated for as long as six weeks later, according to a study published Feb. 29 in Nature Medicine.
Researchers from Massachusetts General Hospital and Brigham and Women’s Hospital looked at data on disasters that caused $1 billion or more in damages, including floods, winter storms and hurricanes. A week after a disaster, emergency department visits by older adults remained 1.22% higher than they were before the weather events, and deaths among the population remained 1.4% higher.
In areas with the most severe storms, older adult death rates stayed elevated for as much as a month and a half. U.S. counties that experienced the worst economic losses from disasters had senior death rates that were two to four times higher than rates in other counties.
The study emphasizes how damage to infrastructure, such as power outages and transportation barriers, can harm health long after disasters, the researchers said. Older adults are at increased risk of harm from disasters because they tend to have more health conditions, lower social connections and greater vulnerability to extreme heat and cold, among other factors.
Study author Renee Salas, an emergency medicine physician at Massachusetts General Hospital and a leader on the annual The Lancet Countdown on Health and Climate Change, said the results underscore the importance of strengthening health systems in the face of disasters, which continue to worsen with climate change.
In 2023, there were 28 confirmed climate disaster events in the U.S., with losses exceeding $1 billion each, including droughts, wildfires, cyclones and flooding, according to the National Oceanic and Atmospheric Administration. In comparison, there were only three such destructive events in 1980, 12 in 2008 and 20 in 2021, the agency said.
Air pollution disparities widening
Gaps in air pollution exposure have increased between communities of color and neighborhoods with primarily white residents, with minority populations receiving the brunt of health harms, new research says.
People of color have almost 7.5 times higher rates of childhood asthma and 1.3 times higher risks of dying prematurely from exposure to polluted air, according to a study published March 6 in Environmental Health Perspectives.
Researchers at George Washington University examined data on nitrogen dioxide, emitted by cars, trucks and other vehicles, and fine-particle pollution, also known as PM2.5. They found that racial and ethnic disparities for both pollutants widened during the past decade.
When comparing the least and most white communities in U.S., disparities in premature deaths caused by PM2.5 increased by 16%, the study found. Comparing the least and most Hispanic communities, disparities in PM2.5 deaths widened by 40%. The pollutant was linked to almost 50,000 deaths in the U.S. in 2019.
Childhood asthma rates also experienced similar increases in gaps, with disparities across different racial groups growing by 19% over the past 10 years. Nearly 115,000 new cases of childhood asthma were linked to nitrogen dioxide in 2019.
The study estimated that costs related to the premature deaths and asthma cases totaled about $466 billion. Researchers said the findings show that federal air quality standards are not adequately protecting minority communities, which are more likely to be located near major roadways and industrial areas.
Gun violence exposure common for Black, American Indian and Alaska Native people
Black and American Indian and Alaska Native people in the U.S. are at higher risk of becoming victims of gun violence. A new study finds they are also commonly exposed to gun violence in their communities and regularly have access to firearms.
The findings, published March 4 in JAMA Network Open, draw attention to gun violence risks in communities that are disproportionately affected by the problem. Led by the New Jersey Gun Violence Research Center, the study found that about 22% of Black and 30% of American Indian and Alaska Native adults had been threatened with a firearm. Nearly 40% of people in both groups reported they personally knew someone who had been shot.
The study also found that 30% of Black people and 45% of American Indian and Alaska Native people had firearms in the home, but only half of those people said their guns were securely stored. Few gun owners regularly carried firearms outside their homes, but those that did cited self-protection, protection of others and mistrust of police as reasons for doing so. Firearm owners were more likely to be male and live in rural areas.
Across all U.S. population groups, firearm homicides rates increased almost 35% from 2019 to 2020, with the highest death rates among Black Americans, according to prior research from the Centers for Disease Control and Prevention. From 2019 to 2022, gun-related suicides also rose, with a 66% increase — the highest for all racial and ethnic groups — among American Indian and Alaska Native people, CDC found.
The Watch is written by Michele Late, who has more than two decades of experience as a public-health journalist.
