1. Hill, Michelle

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I read the article by Zrelak1 and applaud the suggestion to decrease the use of cerebrovascular accident as a descriptor of stroke. I would disagree with the suggestion to stop labeling stroke patients as victims, as suggested by the author. Although it is true that the cause of stroke is based on modifiable risk factors, it would be remiss of the stroke world to neglect social and racial disparity when considering who is a victim of stroke.


For the average non-Hispanic, non-African patient, risk factor modification may be easy. Take for example myself; I am a middle-aged White woman with insurance who sees a doctor every year and is up-to-date on health screenings. My physician is 3 miles from my home, covered by my insurance and part of the healthcare organization by which I am employed. The same is true of any specialist I see. I have constant access through online apps and messaging with my physicians and their staff. I am healthcare savvy and stay on top of screenings and physicals.


Consider a non-English-speaking patient who experiences a stroke. His/her risk factors may be very different than mine; he/she may or may not have a primary care physician, may or may not have insurance, and may not have an understanding of the English language. Consider other patients who experience a stroke. The National Institutes of Health has published a 3 times higher incidence of death in the 45- to 54-year age range for African Americans who experience stroke and a higher incidence of hypertension and diabetes.2 We know racial and ethnic minorities have a higher incidence of stroke and worse outcomes, but it is our job to determine why.2


Why do we see disparity? Is this related to socioeconomics, trust in the healthcare system, access to care, low healthcare literacy, or simply a matter of education?3


I would challenge the opportunity is not with how we phrase stroke but rather with how we help prevent stroke. How are we reaching out to bridge the gap in our communities? How are we educating minority groups and fostering a trusting relationship? How are we ensuring our minority populations have access to medications they can afford? How can we ensure they have access to a physician? How can we ensure they have access to affordable healthy food? This is how we move stroke from being an accident to something preventable.




1. Zrelak PA. Why stroke is not a cerebrovascular accident and there are no victims. J Neurosci Nurs. 2020;53(1):24-25. doi:10.1097/JNN.0000000000000558 [Context Link]


2. Howard G, Moy CS, Howard VJ, et al. Where to focus efforts to reduce the black-white disparity in stroke mortality: incidence versus case fatality?Stroke. 2016;47(7):1893-1898. doi: [Context Link]


3. Morgenstern LB, Kissela BM. Stroke disparities: large global problem that must be addressed. Stroke. 2015;46(12):3560-3563. [Context Link]