JMIR Publications

ABSTRACT

Background:

Social inequities affecting minority populations after Hurricane Katrina led to an expansion of environmental justice literature. In August 2017, Hurricane Harvey rainfall was estimated as a 3,000 to 20,000 year event. To address dual concerns of urban flooding and disproportionate stroke prevalence among minorities, Stomp out Stroke, a patient-centered community outreach intervention, focused on improving knowledge of race/ethnicity specific healthcare needs.

Objective:

Our study addressed social inequities in minority cerebrovascular health through (1) the identification of race/ethnicity specific healthcare needs and (2) the provision of structured stroke prevention screening during two annual community engagement events (May 2018 and May 2019).

Methods:

Stomp out Stroke registrant surveys (age>18 years) detailed sociodemographic characteristics, family history of stroke and stroke survivorship. Participant healthcare interests’ were assessed. Comparisons by race/ethnicity [Asian, African-American(AA), Hispanic or non-Hispanic White (NHW)] were conducted using Kruskal-Wallis or Chi-square test. P < 0.05 equaled a statistically significant difference between >2 groups.

Results:

A total of 1401 people registered for Stomp out Stroke. Registrants were 70% female, median age 45 years. Participants largely self-identified as members of minority groups - 32% Hispanic, 26% AA, 14% Asian compared to 24%NHW. Stroke survivors comprised 11% of our population (n=155), 124 stroke caregivers participated. Approximately 37% of participants had a family history of stroke (n=493). AAs were most likely to have Medicare/Medicaid insurance (24.6%); Hispanics were most likely to be uninsured (29.2%). Hispanics were more likely than NHW to obtain health screenings (62.8 vs 52.9%; P=0.03). Asian and AAs were more likely to request stroke education than NHWs or Hispanics (55 or 56% vs 41.7 or 43%). AAs were more likely to seek overall health education than NHWs (46.2 vs 32.65%; P<0.01). NHWs were less likely than AAs or Asians to speak to healthcare providers (14.5 vs 25.3 or 28.3%). During the 2018 and 2019 events, 2774 Health Screenings were completed. These screenings included Blood Pressure (n=1031, 37.2%), Stroke Risk Assessment (n=496, 17.9%), Bone Density (n=426, 15.4%), Carotid Ultrasound (n=380, 13.7%) , Body Mass Index (n=182, 6.5%), Serum Lipids (n=157, 5.6%) and Hemoglobin A1C (n=102, 3.7%).

Conclusions:

Stomp out Stroke identified race/ethnicity specific healthcare needs and provided appropriate screenings to minority populations at increased risk of urban flooding and stroke. This community engagement protocol can be replicated in Southern US “Stroke Belt” cities (New Orleans LA, Charleston SC, Savannah GA) with similar flood risk.