Abstract 2279: Ethnic Comparisons in Pre-Stroke Awareness and Treatment of Hypertension in Stroke Subjects: Modification by SES and Acculturation

Abstract

Background and Objectives: Mexican Americans (MAs) have higher stroke incidence rates than non-Hispanic whites (NHWs). Ethnic differences in the pre-stroke treatment of risk factors could potentially explain this disparity and may be exacerbated by low socio-economic status or less acculturation. We assessed pre-stroke awareness and treatment of hypertension by ethnicity, education and English proficiency in a population-based stroke surveillance project. Methods: Among 1,111 stroke subjects aged ≥45 years in the Brain Attack Surveillance in Corpus Christi (BASIC) project from 01/2000-06/2006, we examined pre-stroke hypertension prevalence (medical record documentation of hypertension diagnosis) at the time of the index stroke by ethnicity (MA vs. NHW). Among those with prevalent hypertension, we measured awareness (self-report of hypertension) and treatment (self-report of anti-hypertensive medication use). We first compared awareness and treatment of hypertension by ethnicity overall. We then compared ethnic differences in awareness and treatment of hypertension using 2 approaches: 1) after stratification by education (<high school vs. ≥high school); and 2) after dichotomizing MAs by self-reported language fluency. Limited English proficiency (EP) was defined as Spanish only (less accultured) and EP was defined as English only/bilingual (more accultured).We adjusted associations for age, gender, education, diabetes, coronary artery disease, and previous stroke using logistic regression. Results: MAs (mean age 68.3 ± 12.1 years; n=566) were more likely than NHWs (mean age 74.4 ± 11.7 years; n=545) to report <high school education (71% vs. 23%; P<0.001). Thirty-two percent of MAs reported limited EP. Hypertension prevalence was 74% in both MAs and NHWs. There was a trend toward MAs having greater awareness than NHWs (89% vs. 85%; P=0.15) but similar treatment (89-90%) of hypertension. Among high school graduates, we found non-significant trends toward greater awareness but less treatment of hypertension in MAs compared with NHWs ( Figure 1 ). Compared with MAs with EP, NHWs and MAs with limited EP had less awareness of hypertension but similar treatment ( Figure 2 ). After adjustment for socio-demographics and co-morbidities, differences in hypertension awareness were no longer significant (NHWs: aOR, 0.96; 95%CI, 0.52-1.79; MAs with limited EP: aOR, 0.57; 95%CI, 0.27-1.19; MAs with EP: referent). Conclusion: We found little evidence that differences in pre-stroke awareness and treatment of hypertension may explain ethnic disparities in stroke.