The recent release of the first-ever evidence-based guidelines for prevention of stroke in women has raised awareness about a health threat that’s gone under the radar for too long. Nationally, strokes are the third-leading cause of death in women but only the fifth-leading cause of death in men, and women face risk factors that men don’t, such as pregnancy complications and hormone use.
The stepped-up prevention effort should be particularly welcome in Maine, where at least one woman dies of a stroke every day. Indeed, the stroke death rate in Maine (for both women and men) is the highest in New England. Low-income people are much more likely than others to have strokes, and the cost of preventive care in a state with a high poverty rate has made it harder for many women to take steps to reduce stroke risk.
Access to health insurance is important to everyone, but it’s particularly pertinent to women, who generally earn less than men, pay more in out-of-pocket health care expenses and are more likely than men to deal with multiple chronic illnesses — driving up their care costs.
That’s why it’s critical for legislators to accept funds to expand Medicaid, halting the progress of a debilitating and too-often deadly disease and ensuring that thousands more Maine women can access the care they need to lead healthier lives.
RISK FACTORS, RECOMMENDATIONS
Also known as a “brain attack,” a stroke occurs when the blood supply to the brain is stopped because of a blood clot or the narrowing of an artery, causing nerve cells to die because they don’t get enough oxygen. Consequences can include paralysis, memory loss and impaired speech.
Women share many of the same stroke risk factors as men: obesity, smoking, diabetes, high blood pressure (also known as hypertension) and high cholesterol. They also have unique risk factors. Taking oral contraceptives can raise stroke risk in women with hypertension. And during pregnancy, women can develop dangerously high blood pressure, which can cause a seizure and double the risk of stroke later in life.
The American Medical Association calls for women to be screened for high blood pressure before starting on contraceptive pills. It also recommends blood pressure medication for pregnant women with very high blood pressure and suggests considering it for pregnant women with moderate hypertension.
Women no longer in their childbearing years need screening for hypertension, diabetes, certain kinds of migraine headaches and irregular heartbeat, all of which tend to boost women’s risk of stroke more than they do for men, according to the AMA.
THE HEALTH CARE GAP
Of course, offering recommendations for reducing stroke risk presumes that a woman has a family doctor and access to regular care. Uninsured women — who account for 53,000 of Maine women, or 12 percent of all women in the state ages 18 to 64 — are less likely to have either than are insured women, according to an analysis of a survey of women with family incomes of $35,000 per year or less.
Researchers also have found that uninsured women are more likely to forgo preventive and other medical services because of cost; to get lower-quality services when they are in the health care system, and to be in poor health.
These findings make for a bleak prognosis regarding stroke prevention. The forecast doesn’t get any brighter, given that uninsured women don’t make a lot of money (41 percent live below the poverty line). Poorer people are more likely than their higher-income peers to smoke and less likely to exercise and eat a healthy diet, all of which contribute to the hypertension that is the leading cause of stroke.
Now Maine has a second chance to accept federal funds to expand Medicaid (known here as MaineCare) under the Affordable Care Act, providing health insurance to as many as 70,000 Mainers through 2016. If legislators agree to cover more low-income workers, an estimated 25,000 to 30,000 Maine women would benefit.
CUTTING TREATMENT COSTS
These are women who don’t have the money to pay for care out of pocket. With annual incomes of up to $16,105 for an individual and $27,311 for a family of three, they make too much to qualify for MaineCare but too little, even with subsidies, to cover the out-of-pocket expenses of people in the health insurance exchanges. Expanding eligibility standards would give them access to preventive services such as obesity and tobacco use screenings and counseling about how to lose weight and stop smoking, which address major stroke risk factors.
If the humane argument for passing the expansion doesn’t hit home, there’s also a fiscal case to be made for funding measures to reduce the risk of stroke — keeping in mind that 83 cents of every $1 spent on Medicaid goes to treating stroke and other chronic diseases.
Though stroke is less prevalent in Maine than hypertension and heart disease, it’s the most costly to cover: It costs $7,090 apiece to treat each MaineCare recipient who has a stroke, adding up to more than $55 million per year in taxpayer funds. So by helping lower the incidence of this preventable, manageable chronic condition, MaineCare expansion ultimately could lower health care costs.
By expanding MaineCare eligibility, Maine lawmakers have an opportunity to do both the right thing and the smart thing by Maine’s uninsured women. Gender-specific stroke-prevention guidelines can help women only if women have a caregiver who can help them carry out these potentially life-saving recommendations.