Chapter 1 - Stroke

Abstract

Although deaths attributable to stroke have declined, it remains a prominent cause of morbidity. According to the Global Burden of Disease Study, in 2016, stroke was the second most common cause of disability-adjusted life years. Disparities exist among stroke risk factors and subsequent disability burden and mortality within the United States. Many of these disparities are linked to socioeconomic status, healthcare infrastructure, and race/ethnicity. Additionally, the incidence of stroke is not equivalent across global regions such as in Asia and Eastern Europe, where deaths attributable to stroke are higher than in the Western world. There are several phases of stroke care. Primary prevention and secondary prevention focus mainly on reducing modifiable risk factors. Tertiary prevention focuses on improving poststroke outcomes. In the United States, Hispanics/Latinos and African Americans receive less intensive stroke rehabilitation, education, and counseling than non-Hispanic Whites. Low- and middle-income countries (LMICs) typically have higher stroke burden than high-income countries (HICs) and fewer resources for poststroke interventions. Greater emphasis on recovery could have both clinical and societal benefits, yet the prevalence of stroke survivors receiving rehabilitation is lower than established guidelines. These guidelines are often difficult to implement in resource-limited settings and create fragmentation across the poststroke care continuum. This is especially true in LMICs where access to skilled therapists and rehabilitation facilities may be scarce. The variation in availability, referrals, structure, and effectiveness of stroke rehabilitation leads to significant gaps in care and increased likelihood of readmission, poor outcomes, and health expenditures. A potential solution in both HICs and LMICs may be more focused on community-based services.