EVALUATION OF STROKE DISPARITIES IN NATIVE HAWAIIANS AND OTHER PACIFIC ISLANDERS

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Intracerebral hemorrhage (ICH) is a devastating hemorrhagic stroke that accounts for 10-15% of the approximately 700,000 annual strokes in the Unites States and results in disproportionately high morbidity and mortality. To date, there is no definitive treatment that results in reversal of neuronal injury and improvement in outcome after ICH. Therefore, it is important to identify the high-risk group and focus on primary and secondary prevention to reduce the incidence and burden of ICH. Recent evidence suggests that the burden of ICH is not borne equally by all, with racial minority groups reported to have a higher incidence and poorer outcomes than whites. Although Native Hawaiians and other Pacific Islanders (NHPI) have been reported to have higher burden of cardiovascular diseases compared to other major racial-ethnic groups, the burden of vascular risk factors related to ICH in this population has not been adequately studied. Furthermore, long-term functional outcome and quality-of-life measures after ICH among NHPI have not been studied. The overall strategy for this project will be to build on the findings from our preliminary work on ICH disparities, utilizing the clinical and research expertise at The Queen's Medical Center, a university-affiliated hospital that is the primary tertiary referral center in the Pacific and has the largest stroke service in the state. We plan to prospectively identify patients who are hospitalized at The Queen's Medical Center for acute ICH, and assess racial disparities in clinical and sociodemographic risk factors and long-term disease-specific health-related quality of life and functional outcomes, which will be measured at 3-, 6-, and 12-month from admission. We hypothesize that NHPI race is associated with younger age of presentation with ICH, better quality of life and less disability at 3 months after ICH compared to other major racial-ethnic groups in Hawaii. In addition, we will develop and test, in a randomized controlled pilot study, the impact of a culturally-informed, stroke-specific Patient Navigation program on psychological health-related quality of life and post-stroke depression among the ICH survivors.