Māori living outside main urban centres are less likely to survive a stroke and it is not all down to postcode healthcare, a recent study shows.
File image Photo: Wiki commons
Research published in the New Zealand Medical Journal asked survivors about their experience of stroke care in hospital and rehabilitation in the community.
It was part of long-running research, REGIONSCare, conducted by researchers from the Universities of Otago and Auckland and other partner organisations.
Māori stroke patients were found to be 75 percent more likely to die within 12 months and those living outside urban centres experienced the worst outcomes overall.
Research programme leader Professor Anna Ranta said postcode healthcare only explained so much.
"It's very concerning. We're demonstrating that we're doing really great care for some people and not very great care for other people and that inequity feels immoral."
People needed medical care within hours of having a stroke for their best chance of recovery and preventing further strokes, she said.
The research found factors often used to explain ethnic disparities, such as underlying health risks, were not valid.
"Really there weren't a lot of other things that could explain it which left us with a notion that there must be some institutional racism and unconscious bias."
The researchers held 10 focus groups with stroke survivors across the country to explore their experiences, challenges, and how to overcome them.
Participants reported major gaps and inconsistencies in the community care received following their stroke, including in waiting times and access to therapy.
"Most waited one to two weeks for follow-up care, but others waited two to five months, so people felt they had not reached the full potential of their recovery, or had ended up paying for disability living aids themselves," Ranta said.
Participants said stroke care needed a raft of improvements - including better access to specialist stroke care units, more support after being discharged and a focus on providing culturally safe care to Māori.
Ranta said one in four adults over the age of 25 years would have a stroke in their lifetime and the experience of stroke patients showed more needed to be done to support them.
"They've just had their life taken away from them and there's no resource to provide them support and so really we need investment, we need to make stroke a priority and we need to make it a priority that we address these inequities so everyone can have the best care and outcomes."
As a result of the findings, researchers are collaborating with Māori health providers and consumers, the Ministry of Health, the National Stroke Network and the Stroke Society of Australasia to develop education programmes on cultural safety and to actively collaborate with Māori and non-urban stroke survivors to improve stroke care.
Ranta said the research participants who were able to access specialist stroke units generally praised their multi-disciplinary approach, their stroke expertise, and the coordination of care.
There are an estimated 9000 strokes a year in New Zealand, a figure expected to increase by 40 percent in the next decade.
Stroke admissions drop
Researchers were concerned the number of stroke patients accessing hospital care had dropped during the pandemic.
The number of strokes had not decreased and there was a proven increased risk of having a stroke in people who have contracted Covid-19, Ranta said.
"We've seen more of a reduction in stroke presentations because of Covid, not because there are fewer strokes but because people with mild strokes have been so afraid of being infected by going to the hospital that they haven't presented."
It was a global trend, Ranta said.
"It's a real problem because the mild strokes (are) where we can intervene to prevent the big stroke."