Why Are African-Americans Less Likely To Call 9-1-1 During A Stroke?

African-Americans have more strokes than other races/ethnicities, but are less likely to use emergency services. Peter Vanderheyden | Flickr vi

African-Americans know the signs of a stroke, but have reservations about calling 9-1-1 and seeking medical care, accordng to a focus-group study based in Michigan.

Stroke is the fourth leading cause of death for all Americans, but African-Americans have a higher chance of dying from a stroke than any other race or ethnicity. The risk for a stroke in African-Americans is almost twice that of whites.

Treatment options are limited, but do exist if the condition is caught early. Clot-busting drugs can remove the stroke-causing obstruction in arteries, but, in general, can only be administered in the first 3 to 4 hours of a stroke.

A 2011 study found that fewer African-Americans call 9-1-1 immediately after experiencing stroke symptoms. This survey of 253 African-Americans in Washington, D.C. found that 89 percent said they would call 9-1-1 at the first sign of a stroke.

However, less than 15 percent of 100 actual stroke patients called 9-1-1 right away when faced with symptoms. Three out of 4 stroke victims called a friend or family first, and only half arrived at the hospital via an ambulance.

Neurologist Dr. Lesli Skolarus led a team of stroke specialists and public health experts into Flint, Mich. to find out why African-Americans don't seek emergency care promptly during a stroke. Hospitalization rates for stroke in Flint are amongst the highest in the state, and 56 percent of Flint's population is African-American, according to the 2010 U.S. Census.

Local church leaders were consulted in order to recruit a focus group of 77 African-Americans. Thirty-nine were kids (aged 11-16), while the remaining volunteers were adults. Of the adult group, 40 percent had attended college or have an advanced degree.

Both groups described stroke as an emergency and said they could recognize the symptoms. However, few knew about the medical options and how time is a critical factor in stroke treatment.  

"Overwhelmingly adult and youth participants recognized that stroke was an emergency," says Skolarus. "But to increase 9-1-1 calls for stroke, interventions will need to address factors beyond identification of stroke warning signs."

Most of the adults listed the cost of an ambulance ride as a major barrier to calling 9-1-1 for themselves. Researchers note that the respondents in previous studies of the same community are more amenable to the idea of requesting emergency medical services (EMS) if it could save a family member or friend.

The authors recommend stroke-preparedness training for these communities, with a special emphasis on how timely medical interventions can prevent post-stroke disability and death, as well as reduce long-term health care costs. This training should also include of description of how the Patient Protection and Affordable Care Act will likely cover EMS for many currently uninsured, which may impact the perceived-cost of calling 9-1-1.

Most of the participants were open to learning about stroke preparedness, and generally agreed that these workshops be conducted at church. Many of the teens said they felt severe anxiety whenever they called 9-1-1 during an emergency. Hence, these classes could also incorporate relaxation techniques to dampen feelings of panic during a crisis.

"Listening to the community is critical in developing the kinds of stroke awareness campaigns that can save lives," says senior author Dr. Lewis Morgenstern, director of the University of Michigan Stroke Program and an epidemiology professor.

The study was conducted in partnership with Bridges to the Future, a youth development program based in Flint.

 

Sources: Skolarus LE, Murphy JB, Zimmerman MA, Bailey S, Fowlkes S, Brown DL, Lisabeth LD, Greenberg E, Morgenstern LB. Individual and Community Determinants of Calling 911 for Stroke Among African Americans in an Urban Community Circ Cardiovasc Qual Outcomes. 2013.

Hsia AW, Castle A, Wing JJ, Edwards DF, Brown NC, Higgins TM, Wallace JL, Koslosky SS, Gibbons MC, Sánchez BN, Fokar A, Shara N, Morgenstern LB, Kidwell CS. Understanding reasons for delay in seeking acute stroke care in an underserved urban population. Stroke. 2011.

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