BU Center for Brain Recovery Researchers Work to Address Health Disparities in Post-Stroke Aphasia

Addressing Health Disparities in Post-Stroke Aphasia

Stroke recovery is a journey that extends beyond the physical healing process, delving into the realms of communication and social integration. For many, the aftermath of a stroke includes aphasia – a condition characterized by difficulty in speaking, understanding language, writing, or reading. However, not all stroke survivors face these challenges equally. Recent research being done at Boston University sheds light on the stark disparities that exist in post-stroke aphasia recovery, particularly among the U.S. Hispanic and non-Hispanic White populations. In this blog we will explore the findings of a study by Manuel Marte, a researcher in the Center for Brain Recovery discussing: “Association Between Social Determinants of Health and Communication Difficulties in Poststroke U.S. Hispanic and Non-Hispanic White Populations” (Marte 2023). Marte’s investigation provides insights into the role that ethnicity, social determinants of health (SDOH), and communication difficulties play in post-stroke recovery.

Methods of the Study

The study conducted a cross-sectional analysis of 2,861 non-Hispanic White and 353 Hispanic poststroke respondents included in the 2014–2018 National Health Interview Survey. This served as the foundation for the paper as respondents were able to self-report difficulties communicating in their usual language, in addition to providing information relating to demographics and lifestyle, health care access and utilization, health status, and SDOH. Marte and his team used several sophisticated statistical measures such as univariate statistics, generalized linear models, and an exploratory mediation analysis to characterize the pattern of differences between these cohorts, examine associations between variables and communication difficulties. Ultimately, the goal was to determine the potential intermediate role of cumulative social determinants of health on the likelihood of reporting communication difficulties.

Understanding the Social Determinants of Health

The findings revealed a more challenging life context for the Hispanic post-stroke population. Interestingly, while Hispanic stroke survivors reported slightly higher rates of communication difficulties, the comparison to non-Hispanic white stroke survivors was non-significant. However, among non-Hispanic whites, factors like poverty and limited internet access were associated with a higher likelihood of communication difficulties overall. Critically, the analyses then quantified how much disparities in social determinants of health, like education and internet access, impact ethnic differences in post-stroke communication problems. By modeling complex interrelationships between ethnicity, socioeconomics, and likelihood of reporting communication difficulties, it found social determinants of health explained nearly 61% of ethnicity’s total effect. This highlights the significant impact of socioeconomic factors on the rehabilitation journey of stroke survivors.

This study brings forward the disproportionate challenges Hispanic stroke survivors face, largely attributable to these determinants. The mediation analysis suggests that addressing disparities in SDOH could substantially reduce ethnic disparities in post-stroke communication difficulties. This points towards the need for interventions and policies aimed at improving the socioeconomic conditions of vulnerable populations.

Potential Interventions

The study calls for a new approach to mitigating health disparities through addressing SDOH. The results bring forward the disproportionate challenges Hispanic stroke survivors face, largely attributable to these determinants. Potential interventions could include providing digital literacy training, improving internet access, targeting poverty reduction, and culturally tailoring post-stroke services. These measures not only aim to enhance equity in communication rehabilitation but also seek to reduce the gaps in recovery trajectories across different ethnic groups.

Conclusion

The findings from this study are a clarion call for healthcare professionals, policymakers, and researchers to prioritize the socio-economic barriers that disproportionately impact minority groups in the stroke recovery process. By focusing on modifiable SDOH, we can work towards a more equitable healthcare system where recovery outcomes are not predicated on ethnic or socioeconomic status. Future research should continue to explore effective strategies for addressing these disparities, ensuring that every stroke survivor has an equitable chance at recovery and reintegration into society.

Read the Article
Marte MJ, Addesso D, Kiran S. Association Between Social Determinants of Health and Communication Difficulties in Poststroke U.S. Hispanic and Non-Hispanic White Populations. Am J Speech Lang Pathol. 2024 Jan 3;33(1):248-261. doi: 10.1044/2023_AJSLP-23-00232. Epub 2023 Nov 13. PMID: 37956702.

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