Finances, mistrust of hospitals cause neighborhood disparities in stroke response

A fear of healthcare expenses may cause residents of certain neighborhoods to avoid calling 9-1-1 for suspected stroke symptoms, researchers reported at the International Stroke Conference in Los Angeles.

Principal investigator Shyam Prabhakaran, MD, and colleagues analyzed survey responses of 199 residents from the North Side of Chicago and 165 from the South Side. Only 4.5 percent of North Siders said they were likely to avoid calling 9-1-1 for fear of costs versus 23.5 percent of South Siders.

North Siders were more educated on average while the south side group had more health problems and more recent hospital visits. The population on the North Side of Chicago contains a greater proportion of whites and higher median income than the South Side.

Even though both groups showed a similar knowledge for recognizing stroke symptoms, the researchers identified additional disparities in perception. South Side residents were less likely to believe immediate hospital care improved post-stroke survival and more likely to believe hospitals treated black and white patients differently, covered up mistakes and experimented on patients without consent.

“If you want to change behavior through public interventions, you need to understand the root causes at the neighborhood and group levels,” Prabhakaran said in a press release. “For stroke awareness and preparedness, you must include and address mistrust and financial barriers.”

The research is part of a larger ongoing study aimed at reducing disparities in care and improving early hospital arrival for stroke patients in Chicago, according to the release.

Every minute that passes before receiving proper care worsens a patient’s post-stroke prognosis. First study author Sarah Song, MD, PhD, MPH, said it is critical people call 9-1-1 to ensure the quickest response.

“When you call 9-1-1, it starts a cascade of events directing the hospital, in advance, that there might be a stroke patient coming,” she said. “There's a whole protocol in place at the hospital to streamline potential stroke patients to getting the care they need.”

The researchers said the findings may apply to other urban minority populations in the U.S., but the sample size was small and may not be representative of all Chicago residents.

American Stroke Association spokesperson Joseph Broderick, MD, pointed out the survey responses were collected in a non-emergency situation and may not reflect how a person would act if somebody was actually having a stroke. Perhaps financial worries or mistrust of medical professionals would get pushed aside in the moment and a bystander would indeed call 9-1-1, he said.

Broderick said a neighborhood-based, follow-up study looking at the proportion of stroke patients who arrived at hospitals via ambulance would provide more information.

“If there was a big difference in the actual percentage between the two regions, two neighborhoods, then you would show that yes, this needs to be stopped,” said Broderick, the director of the University of Cincinnati Neuroscience Institute. “These ideas about medical system and doctors and things like that, do they really translate in terms of actions? And if they do, that's a big issue.

“If they don't and you find equally they're calling 911 for the severity of the stroke then it may reflect attitudes that we have to address and educate, but it may not have quite the impact as what this study would suggest.”