Racial and Ethnic Disparities in the Use of Intravenous Recombinant Tissue Plasminogen Activator and Outcomes for Acute Ischemic Stroke

Nasr, Deena M.; Brinjikji, Waleed; Cloft, Harry J.; Rabinstein, Alejandro A.

doi:10.1016/j.jstrokecerebrovasdis.2011.07.003

Cited by 55 publications

(50 citation statements)

References 20 publications

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“…Some previous studies have shown that black patients receive IV rt‐PA 1/5 to 3/4 as often as white patients,8, 9, 21, 22, 23, 24 but other studies have reported no difference in rates of treatment 25, 26. Data for Hispanic patients are also conflicting.…”

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confidence: 96%

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Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Aparicio

Carr

Kasner

et al. 2015

JAHA

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BackgroundPrimary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt‐PA) than non‐PSCs. The impact of PSCs on racial disparities in rt‐PA use is unknown.Methods and ResultsWe used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt‐PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to PSCs. A higher proportion received rt‐PA at PSCs than non‐PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P<0.001). In a multivariable model adjusting for year, age, sex, insurance, medical comorbidities, a diagnosis‐related group–based mortality risk indicator, ZIP code median income, and hospital characteristics, blacks were less likely to receive rt‐PA than whites at non‐PSCs (odds ratio=0.58, 95% CI 0.50 to 0.67) and PSCs (odds ratio=0.63, 95% CI 0.54 to 0.74) and Hispanics were less likely than whites to receive rt‐PA at PSCs (odds ratio=0.77, 95% CI: 0.63 to 0.95). In the fully adjusted model, interaction between race and presentation to a PSC for likelihood of receiving rt‐PA did not reach significance (P=0.98).ConclusionsRacial disparities in intravenous rt‐PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non‐PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt‐PA in the fully adjusted model.

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confidence: 96%

“…Data for Hispanic patients are also conflicting. In one large nationwide population sample, Nasr et al found lower rates of rt‐PA use for Hispanics 24. In a separate study, Hispanic patients had equivalent odds of receiving therapy as white patients 27.…”

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confidence: 97%

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Aparicio

Carr

Kasner

et al. 2015

JAHA

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“…18 These findings are consistent with several prior publications including data from GWTG-Stroke. [19][20][21][22][23][24][25][26] Our current study includes more contemporary treatment data and more extensive adjustment for potential known confounders than many prior studies.…”

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confidence: 99%

Why are acute ischemic stroke patients not receiving IV tPA?

et al. 2016

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Objective: To determine patient and hospital characteristics associated with not providing IV tissue plasminogen activator (tPA) to eligible patients with acute ischemic stroke (AIS) in clinical practice.Methods: We performed a retrospective cohort study of patients with AIS arriving within 2 hours of onset to hospitals participating in Get With The Guidelines-Stroke without documented contraindications to IV tPA from April 2003 through December 2011, comparing those who received tPA to those who did not. Multivariable generalized estimating equation logistic regression modeling identified factors associated with not receiving tPA.Results: Of 61,698 eligible patients with AIS presenting within 2 hours of onset (median age 73 years, 51% female, 74% non-Hispanic white, median NIH Stroke Scale score 11, interquartile range 6-18), 15,282 (25%) were not treated with tPA within 3 hours. Failure to give tPA decreased over time from 55% in 2003 to 2005 to 18% in 2010 to 2011 (p , 0.0001). After adjustment for all covariates, including stroke severity, factors associated with failure to treat included older age, female sex, nonwhite race, diabetes mellitus, prior stroke, atrial fibrillation, prosthetic heart valve, NIH Stroke Scale score ,5, arrival off-hours and not via emergency medical services, longer onset-to-arrival and door-to-CT times, earlier calendar year, and arrival at rural, nonteaching, non-stroke center hospitals located in the South or Midwest.Conclusions: Overall, about one-quarter of eligible patients with AIS presenting within 2 hours of stroke onset failed to receive tPA treatment. Thrombolysis has improved dramatically over time and is strongly associated with stroke center certification. Additionally, some groups, including older patients, milder strokes, women, and minorities, may be undertreated.

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“…Previous studies have shown compelling sex, racial, and socioeconomic disparities in the treatment and outcomes among patients with acute stroke. [5][6][7] Generally, racial minorities and women with acute stroke have lower quality hospital care, 5,[8][9][10][11][12][13] including the use of imaging. These disparities can contribute to inequality in stroke outcomes and are a top research priority of the National Institute of Neurologic Disorders and Stroke.…”

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confidence: 99%

Age, Sex, and Racial Differences in Neuroimaging Use in Acute Stroke: A Population-Based Study

Vagal¹,

Sanelli

Sucharew

et al. 2017

AJNR Am J Neuroradiol

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Racial and Ethnic Disparities in the Use of Intravenous Recombinant Tissue Plasminogen Activator and Outcomes for Acute Ischemic Stroke

Cited by 55 publications

References 20 publications

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Why are acute ischemic stroke patients not receiving IV tPA?

Age, Sex, and Racial Differences in Neuroimaging Use in Acute Stroke: A Population-Based Study

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