Ethnic disparities in the longer-term clinical care and outcomes of stroke patients in England

Ethnic disparities in stroke incidence and recurrence are well-known but there is conflicting evidence regarding post-stroke care and recovery. In the UK, stroke-survivors are recommended a six-month specialist review but fewer than half receive this review, potentially exacerbating health inequities. Using data from the Sentinel Stroke National Audit Programme (SSNAP) from inception to August 2023 across four regions in England with varying ethnicity profiles we conducted a retrospective descriptive analysis to assess ethnic differences in six-month care and outcomes for stroke-survivors. A total of 80,413 (26.2%) stroke-survivors attended their 6-month review (whites: 26.5%, Black patients: 27.9%; Asian patients: 26.1%; Mixed patient: 27.6%; other: 23.5% other; unknown: 23.1%) with a higher proportion of reviews taking place via telephone for Black and Asian patients (X = 955.7, p = 0.001). After adjustment, non-White patients were significantly more likely to be followed up at 6 months (Black patients OR 1.29 (95%CI 1.21–1.38), Asian patients OR 1.10 (95% CI: 1.04–1.15). The odds of having a further stroke (Black OR 1.49 (95% CI: 1.21–1.84), Asian OR 1.25 (95% CI 1.03–1.52)) or other illness requiring hospital readmission (Black OR 1.25 (95% CI: 1.12–1.40), Asian OR 1.15 (1.05–1.27)) were significantly higher in Black and Asian patients following adjustment for age and stroke severity. At six months lipid therapy was significantly lower in Black patients (OR 0.79 (95% CI: 0.72–0.87)). Black and Asian stroke-survivors experience worse outcomes and lower use of secondary prevention despite similar clinic attendance. Culturally sensitive interventions are needed to reduce post-stroke complications.