Neurological

Racial and ethnic differences in the use of stroke thrombolysis are decreasing

Between 2009 and 2018, there was a significant improvement in racial and ethnic differences in intravenous thrombolytic use after stroke in the United States, according to study results published as a letter in the Journal of the American Medical Association (JAMA).

Previous studies reported lower rates of intravenous thrombolysis after stroke among black and Hispanic people in the United States. The aim of the current study was to assess the temporal trends of stroke thrombolysis in the US by race and ethnicity between 2009 and 2018.

Using data from the 2009-2018 national inpatient sample, patients admitted to hospital for ischemic stroke were identified, and proportions and percentages of intravenous thrombolytic use by race and ethnicity and year were calculated.

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The study included 752,369 ischemic stroke discharges (mean age 72 years; 51.9% women; 68.9% whites). The use of intravenous thrombolysis increased between 2009 and 2018 in patients who were white (from 4.6% to 10.9%), Hispanic (from 3.2% to 12.3%), and black (from 3.7% to 10.2%).

Over the 10-year period, intravenous thrombolysis rates were lower in people of all races and ethnic minorities than in white patients (adjusted odds ratio [OR], 0.90; 95% CI, 0.88-0.93). However, the gap between people from all racial and ethnic minorities combined with white people increased between 2009 (adjusted OR, 0.81; 95% CI, 0.70-0.93) and 2018 (adjusted OR, 0.95; 95% CI, 0.89–1.02) decreased significantly. (P = .001 for the interaction of race and ethnicity with year) and did not become statistically significant until 2018.

The gap to whites was reduced in blacks (adjusted OR 0.91; 95% CI 0.82-1.00) and disappeared completely in Hispanic individuals by 2014 (adjusted OR 1.08; 95% CI 0.99- 1.18).

One of the main limitations of the study was the lack of information on clinical stroke characteristics, drugs, thrombolytic ability and contraindications.

“This study found that between 2009 and 2018, racial and ethnic differences in IV thrombolysis use improved after stroke, with the gap between blacks narrowing in blacks and disappearing in Hispanic individuals. Possible reasons could be the effectiveness of efforts to reduce stroke inequalities and the increasing organization of stroke care, ”the researchers concluded.

reference

Suolang D, Chen BJ, Wang NY et al. Stroke Thrombolysis Temporal Trends in the United States by Race and Ethnicity, 2009-2018. JAMA. Published online October 11, 2021. doi: 10.1001 / jama.2021.12966

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