Exploring Everyday and Medical Setting Discrimination: Perspectives from a Diverse Stroke Patient Cohort
Mariel Flake-Rojas1, Mengxi Wang2, Gabretta Cooksey1, Caitlynn Carter1, Munachi Okpala3, Jose-Miguel Yamal2, Anjail Sharrief1
1Neurology, 2School of Public Health, UTHealth Houston, 3McGovern Medical School-Division of Adult Neurology, Stroke Team
Objective:

Experiences of discrimination are related to stroke risk. In this study, we assessed the proportion of stroke patients reporting everyday discrimination and discrimination within healthcare contexts, along with the reasons they provide for such experiences.

Background:
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Design/Methods:

We assessed everyday discrimination (EDD) and Discrimination within medical environments (healthcare discrimination: HCD) using validated scales for patients with TIA or stroke enrolled on the VIRTUAL trial (Video-based Intervention to Reduce Treatment and Outcome Disparities in Adults Living with Stroke or TIA) from March 9, 2022 to October 9, 2024. Experiences of discrimination (score > 0) and their reasons were evaluated across age, sex, race, ethnicity, language preference, education (<12th grade vs. => 12th grade), and insurance status.

Results:

450 patients were included with a median age of 63 years and 46.8% female; 36% Black or African American; 30.44% Hispanic/Latino; 15.5% Spanish speaking and 22.2% were uninsured.

92 of 439 (20.4%) reported EDD. Median age was 60.5 years and a nearly balanced sex distribution; 43.5% Black or African American; 39.1% Hispanic/Latino; 19.6% Spanish speaking; 25% were uninsured. Patients reported the following reasons for EDD: race (45.7%), gender (20.7%), age (18.5%), education/income level (16.3%), and ancestry (9.8%).

HCD was reported by 40 of 443 individuals (9.02%), with a median age of 62 years, female (62.5%). By race /ethnicity, 27.5% were Black or African American and 37.5% Hispanic/Latino; 20% Spanish speaking and 22.5% were uninsured. The most frequently cited reasons for HCD were race (25%), education/income level (15%), and age (12.5%), followed by physical disability (7.5%) and ancestry (7.5%).

Conclusions:

This study highlights reported experiences of discrimination particularly within marginalized groups. The results indicate a significant experience in patients with stroke with both on everyday discrimination and healthcare settings. Further research is needed to understand how these experiences of discrimination influence in stroke care and outcomes.

10.1212/WNL.0000000000211483
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