An Epidemiological Perspective on Race/Ethnicity and Stroke
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RACE + ETHNICITY DISPARITIES (K WATSON, T HORWICH, SECTION EDITORS)
An Epidemiological Perspective on Race/Ethnicity and Stroke Jennifer Sevush-Garcy & Jose Gutierrez
Published online: 15 March 2015 # Springer Science+Business Media New York 2015
Abstract Stroke disparities among self-defined ethnic and racial groups exist in the USA and in other countries. While ethnicity carries an inherent cultural connotation, race is less well defined. Emerging evidence suggest that race is more a social construct than a biologically plausible category of humans. Nonetheless, disparities exist in multiple measures of cerebrovascular health across ethnic and racial groups. For example, the risk of stroke among non-Hispanic blacks and Hispanics in the USA is two-to-three times higher than non-Hispanic white population. Although examples of genetic segregation may be invoked to explain these disparities, the evidence reviewed here suggests that important difference exist in environmental and clinical factors that may contribute more importantly to the observed stroke disparities. Despite the caveats of using race and ethnicity as homogenous categories, there is value in using these constructs to target preventive measures in populations at a high risk of cerebrovascular disease. Keywords Disparities . Race . Ethnicity . Stroke . Stroke incidence . Stroke rates . Stroke subtypes . Etiology . Outcomes . Vascular risk factors . Hypertension . Black . White . Hispanic . United States
Introduction In the USA (US), there are well-defined inequalities noted between racially and ethnically defined groups for a range of This article is part of the Topical Collection on Race + Ethnicity Disparities J. Sevush-Garcy : J. Gutierrez (*) Department of Neurology, Columbia University Medical Center, 710 W 168th Street, 6th floor, Suite 639, New York, NY 10032, USA e-mail: [email protected]
complex diseases including cardiac disease, hypertension, diabetes, and stroke. These observed inequalities have led to substantial investigation and debate regarding the concepts of race and ethnicity, particularly in regards to how we define and determine these constructs. The aims of this review are to critically assess what is known about race and ethnicity as biological and/or social constructs; to describe the disparities in stroke prevalence, incidence, mortality, treatment, and outcomes among different racial and ethnic groups; and to discuss the implications that these reported disparities have for health-care workers focused in this area of research.
The Concept of Race and Ethnicity For the study of health disparities among racial and ethnic groups, the implicit question is whether these divisions exist as a natural biological division of mankind or if they exist as a sociocultural phenomenon with biological consequences to the individual [1]. Ethnicity has been defined as a selfreported construct based on geographic, social, cultural, and religious grounds [2]. Given that ethnicity carries a cultural connotation in its definition, we wi
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