The impact of ethnic/racial status on access to care and outcomes following stroke: A narrative systematic review

Improving poststroke outcomes is contingent on early symptom recognition and timely access to life-saving interventions. Several studies have reported differences in access to care among stroke patients from different ethnic/racial backgrounds, although some of the findings present contrasting results. A 2011 AHA/ASA Scientific Statement noted ethnic/racial disparities in access and receipt of stroke care. The aim of this systematic review was to comprehensively identify and describe the impact of ethnic/racial status on access to care after onset of stroke symptoms. We undertook a systematic search of the following databases: Cochrane, JBI, Trove, ProQuest, Ethos, CINAHL, MEDLINE, Embase, PsycINFO, Academic Search Elite, and Scopus to find relevant qualitative, quantitative, or mixed-method studies focused on ethnicity/race, stroke, and access to health care services in adult (≥18 years) stroke patients. A narrative synthesis approach was used to generate key themes describing the impact of ethnic/racial differences in stroke-related care. Twenty-five studies were included in this systematic review. Narrative synthesis yielded 4 key themes related to differences in 1) transportation to hospital, emergency wait time, hospital admission, and length of stay; 2) receipt of intravenous thrombolysis; 3) receipt of mechanical-reperfusion therapies and imaging procedures; and 4) risk of death, based on ethnicity/race. Generally, but not universally, ethnic/racial minorities (particularly black patients) had lower access to poststroke care, but no greater mortality risk. Reducing health-related disparities will improve treatment outcomes among ethnic stroke patients.