Background
A stroke is a medical condition that causes poor blood flow to the brain. Subsequently, the brain cells die, causing severe health issues for the patient. Cardiovascular or coronary heart diseases (CHD) are diagnosed in more than 120 million Americans (Baptiste et al., 2021). Deaths from hypertension, heart failure, and stroke are fifth in the mortality rate of the US population (National Center for Health Statistics, 2022). The NCHS prognoses that by 2035, more than 130 million adults will have CHD (National Center for Health Statistics, 2022). Therefore, the government and the Center for Disease Control (CDC) organize CHD-dedicated programs for fighting and preventing cardiovascular diseases. Among the most influential organizations are the Division for Heart Disease and Stroke Prevention (DHDSP), Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMEN), Paul Coverdell National Acute Stroke Program, and Building GIS Capacity for Chronic Disease Surveillance (CDCP, 2019). All these programs aim to prevent CHD and decrease the US mortality rate.
The Relationship of SDOH to Stroke
Social determinants of health (SDOH) include life conditions such as childhood, working, and learning. The age of individuals also influences the shape of their health and affects the health risks that could worsen the state (Baptiste et al., 2021). In addition, SDOH encompasses the intersection of living: social, economic, and environmental factors. Therefore, an individual’s social and lifestyle conditions can highly influence the risk of developing particular diseases or the likelihood of accessing primary care when a stroke happens. For cardiovascular diseases, economic and social factors are essential. Effective health management, the possibility of having insurance, and sufficient resources to access medical care are primary factors in preventing stroke (Baptiste et al., 2021). Promoting positive health outcomes would require enhancing economic and social conditions.
Health Disparity Leading to Stroke
The health disparity of stroke is based on socioeconomic factors, with most patients unable to prevent and self-manage their health because of unfavorable living conditions. The main factors influencing the likelihood of stroke are high blood pressure, insufficient and high-cholesterol nutrition, harmful environmental conditions, bad habits such as smoking or excessive consumption of alcohol, and low access to professional medical care. The study suggests that SDOH is associated with ED visits, where findings confirm that the risk group for coronary diseases is black, has low income, and is unemployed. It subsequently makes them victims of insurance absence. The additional factors are having insufficient education for a high-paying job and being unmarried. These factors showed high dependence on the likelihood of more than one visit to the ED and a CHD or stroke diagnosis. Therefore, individuals with low social and economic conditions are more likely to be diagnosed with CHD and experience a stroke within the first 12 months after diagnosis.
Health Departments and Local Communities for the Prevention of Stroke
Several initiatives deal with the prevention and disease control of CHD. The Robert Wood Johnson Foundation creates public health campaigns that aim at the awareness and management of diseased populations (National Civic League, 2019). One of the examples of local community programs is The Southeastern San Diego Cardiac Disparities Project. This project focuses on engagement with the community that experiences the country’s highest rates of heart attacks and strokes. Over 6,400 low-income black adults are expected to benefit from the project (National Civic League, 2019). Such foundations and projects have a new approach to recognizing the most at-risk groups and transforming the community.
The transformation of faith organizations and health care is the central idea behind health departments aiming to prevent and monitor strokes. Another example is the Missouri Quality Improvement Network, which focuses on 28 federal health centers. It is helping to adopt the new use of the health information technology (HIT) system (Center for Disease Control, 2019). This initiative would make it easier for health providers to examine and track treatment progress and patient data. Some programs, like WISEWOMEN, provide patients with blood pressure monitors free of charge or assist with transportation and medical costs. All the programs mentioned above include social grants and government funding as part of their core investments (CDCP, 2019). Limited financing and required documentation exist, and some patients have problems applying for such initiatives. Therefore, there are a limited number of grantees, and local communities and departments are not covering all the needed communities.
Gaps in Local Services and Education
The best way to prevent the disease is to follow recommendations and know your risk factors. People who have close relatives or friends who are at risk of having a stroke should be aware of the symptoms of CHD. The CDC (2019) identifies gaps in the support and prevention of heart diseases: no comprehensive national surveillance system, insufficient cohort studies, and significant impact on the elderly population.
The limitations of government or local programs to prevent strokes include focusing on short-term outcomes rather than long-term SDOH factors, limited patient-level information, and no individual follow-up for those who have experienced a stroke (National Center for Health Statistics, 2022). Hospitals report high re-admission rates for those who have had a stroke and report 30-day mortality for hospitalized patients.
Recommendations for Health Equity
For future initiatives and projects related to CHD, it is essential to develop expertise in using administrative data to monitor heart-related diseases. For hospitals and health providers, the critical step toward enhancing treatment would be the combination of data resources into one standard data system. Moreover, including SDOH factors and careful examination of statistics would allow the creation of productive programs to reduce stroke mortality. The factors that must be considered for future reference are social, economic, lifestyle choices, access and the availability of care to patients with financial issues, the number of registrations, and the patient’s previous medical history.
References
Baptiste, D. L., Turkson-Ocran, R. A., Han, H. R., Himmelfarb, C. D., & Commodore-Mensah, Y. (2021). Social determinants of emergency department visits among persons diagnosed with coronary heart disease and stroke. Ethnicity & Disease, 31(1), 41-46. DOI: 10.18865/ed.31.1.41
National Center for Chronic Diseases Prevention and Health Promotion. (2019). CDC Investments in heart disease and stroke prevention.
National Center for Health Statistics. (2022). Cerebrovascular disease or stroke.
National Civic League. (2019). How congregations are getting to the heart of health. Robert Wood Johnson Foundation.