Date of Award

5-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Applied Health Research and Evaluation

Committee Chair/Advisor

Dr. Moonseong Heo

Committee Member

Dr. Kathleen B. Cartmell

Committee Member

Dr. Joel Williams

Committee Member

Dr. Lu Shi

Committee Member

Dr. Mayowa Owolabi

Abstract

Stroke is the second leading cause of death and the third leading cause of disability globally. Of the two major classes of stroke, mortality is more associated with hemorrhagic stroke (HS) than ischemic stroke (IS) cases. Regardless of the type, a stroke episode is a medical emergency that, in the absence of timely intervention, could result in death, exert devastating effects on individuals, families, and communities and incur substantial economic losses, hence making it a disease of public health significance.

Despite the remarkable advances in stroke research and medical care, stroke disparities have persisted among individuals of African Ancestry who bear enormous burdens in terms of stroke risk factors, morbidity, and mortality. Stroke-related mortality is 70% higher among African American men compared to White men, and a 1-month fatality rate of up to 40% has been reported among Indigenous Africans.

Several studies have examined the challenges of stroke disparities among African Americans compared to other racial groups in the USA and have alluded to socioeconomic differences and social injustices as factors responsible for the disparities. However, there is a dearth of studies that explore stroke epidemiology among African Americans and Indigenous Africans, which, despite having existed in different geographical locations for almost 200 years, persistently remain on the public health radar for stroke disparities.

Consequently, this dissertation sought to identify novel targets for interventions to combat the burgeoning effect of stroke among individuals of African ancestry under these three aims: 1.) Determine disparities in HS hospital admissions and identify factors associated with a higher risk for HS compared to IS among West Africans (WA) and African Americans (AA); 2.) Identify factors associated with timely arrival for stroke care (TASC) among WA and AA, and 3.) Determine the disparities in the length of hospital stay (LOS) and hospital stroke mortality rates between WA and AA.

To achieve the aims above, we conducted secondary data analysis on 2013 – 2022 data obtained from comprehensive stroke centers in West Africa and the USA. Under Aim 1, we observed that HS admission was higher among WA (32.88%) compared to AA (20.71%); both groups had similarities and variations in the risk factor profile associated with higher risk for HS. However, AA stroke patients had higher proportions of the risk factors (diabetes, hypertension, depression, and obesity) compared to WA stroke patients. Regarding Aim 2, TASC adherence was higher among AA (38.54%) compared to WA (16.45%) (p

Targeted interventions should be designed to address stroke risk factors, especially among younger aged AAs. Furthermore, referral protocols should be upgraded to increase TASC rates, and more stroke care units should be established in WA to improve stroke patient outcomes.

Author ORCID Identifier

orcid.org/0000-0002-8156-4195

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