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Why Black Americans have the highest death rate from strokes

Jonathan House suffered from a stroke in 2021 and is lucky to be alive. So why are strokes more common in Black Americans, and what's being done to change it?

LOUISVILLE, Ky. — On average, someone in America has a stroke every 40 seconds. Strokes are the 5th leading cause of death in America.

But, if you take a more critical look at the numbers, you’ll see that one ethnic group carries the weight of the worst stroke statistic. 

Black Americans have the highest death rate from strokes than any other racial group.

The good news is that the factors that lead to strokes are identifiable through primary care and often preventable. 

“We can go out here and do a survey, and ask 100 of us, all black males, how long has it been since you had your blood pressure checked,” asks Jonathan House, a recent stroke survivor. “I’ll bet you some of them will tell you years,” he said. 

In November of 2021, House says, his blood pressure was off the charts when he collapsed from a stroke. 

At the time, he was also grief-stricken from the recent loss of his mother and step-father. And, he says he was overly stressed after the loss of the job he had for more than 20 years.  

“In us black males,” he said, “high blood pressure, stress, diabetes, stuff we don’t look at along with the weight of the world. All of that all piles in on you. After so long, walking around with it on your shoulders, we get weak. But, as we get weak not knowing that it’s tearing us down inside out, and we don’t know it. A lot of us don’t know it until it’s too late.” 

House is 45 years old and is lucky. He survived. Today, he’s on the mend and hoping to make a full recovery. But he’s still managing high blood pressure and diabetes, factors that often play a direct role in causing strokes.

“Mr. House in particular, really exemplifies a lot of the challenges as far as stroke risks with the African- American community,” said Dr. Danny Rose, a Neurologist, and Stroke specialist at the Norton Neuroscience Institute 

“It’s been well recognized in all aspects of medicine that African- Americans and other minority groups have worse outcomes,” he said. “There’s a disparity in both the outcomes and the care that these patients receive. From a prevalence standpoint, Black Americans actually have the highest rate both of stroke as well as death from stroke, compared to any other racial or ethnic group. And that’s been known for a long time.” 

The common risk factors for stroke are high blood pressure, diabetes, and smoking. But Dr. Rose points out that those risk factors are common in multiple ethnicities and geographic areas. 

So, it doesn’t fully explain why there is a higher prevalence of strokes among African Americans- or why African Americans have the highest death rate when it comes to strokes. 

“When we look at our stroke studies,” Dr. Rose says, “they all look at populations of people. So, studies conducted in the United States ideally should have the United States’ rough breakdown of racial ethnicities. And what that means is, if you are a white person you are much more likely that you and your genetic makeup will be more reflected in this research, because there’s just a higher prevalence as far as an ethnic group."

Dr. Rose went on to say that this really puts minorities at a disadvantage because, "our research that guides our treatment decisions are all just predominantly featuring people of whiter European ancestry."

This is now part of the health equity conversation in American Medicine. Dr. Rose says this is the lens through which new studies must look. 

“Part of healthcare equity is looking at how do we individualized treatments and give more specific research toward ethnic minority groups to really try to focus on what problems are unique to that population, what interventions may provide a unique benefit to that population, and that’s something that has really been understudied, to be honest for a long time," he said.

"But, I think that people‘s eyes are really starting to open to see if we really want to reduce disparity and healthcare systems, we need to study why the disparities are happening, and we need the trial interventions on large scales to see what works and what does it.” 

It's work appreciated by patients like Jonathan House. 

“I have a lot of life left in me,” House said. “I’m going to fight as long as I can fight because I know, if I lay down, I’m going to die. I know it. I’m not going to give up. I’m going to get myself all the way back together.” 

Doctors say, the most important thing you can do is have your blood pressure checked, and schedule an appointment with a primary care doctor, and see that doctor regularly. 

The top killers of black men, strokes included, are all detectable and on some level preventable through primary care.

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