TY - JOUR
T1 - Racial disparities in tissue plasminogen activator treatment rate for stroke
T2 - A population-based study
AU - Hsia, Amie W.
AU - Edwards, Dorothy F.
AU - Morgenstern, Lewis B.
AU - Wing, Jeffrey J.
AU - Brown, Nina C.
AU - Coles, Regina
AU - Loftin, Sarah
AU - Wein, Andrea
AU - Koslosky, Sara S.
AU - Fatima, Sabiha
AU - Sánchez, Brisa N.
AU - Fokar, Ali
AU - Gibbons, M. Chris
AU - Shara, Nawar
AU - Jayam-Trouth, Annapurni
AU - Kidwell, Chelsea S.
PY - 2011/8
Y1 - 2011/8
N2 - Background and Purpose-Some prior studies have shown that racial disparities exist in intravenous tissue plasminogen activator (tPA) use for acute ischemic stroke. We sought to determine whether race was associated with tPA treatment for stroke in a predominantly black urban population. Methods-Systematic chart abstraction was performed on consecutive hospitalized patients with ischemic stroke from all 7 acute care hospitals in the District of Columbia from February 1, 2008, to January 31, 2009. Results-Of 1044 patients with ischemic stroke, 74% were black, 19% non-Hispanic white, and 5% received intravenous tPA. Blacks were one third less likely than whites to receive intravenous tPA (3% versus 10%, P<0.001). However, blacks were also less likely than whites to present within 3 hours of symptom onset (13% versus 21%, P=0.004) and also less likely to be tPA-eligible (5% versus 13%, P<0.001). Of those who presented within 3 hours, blacks were almost half as likely to be treated with intravenous tPA than whites (27% versus 46%, P=0.023). The treatment rate for tPA-eligible patients was similar for blacks and whites (70% versus 76%, P=0.62). Conclusions-In this predominantly black urban population hospitalized for acute ischemic stroke, blacks were significantly less likely to be treated with intravenous tPA due to contraindications to treatment, delayed presentation, and stroke severity. Effective interventions designed to increase treatment in this population need to focus on culturally relevant education programs designed to address barriers specific to this population.
AB - Background and Purpose-Some prior studies have shown that racial disparities exist in intravenous tissue plasminogen activator (tPA) use for acute ischemic stroke. We sought to determine whether race was associated with tPA treatment for stroke in a predominantly black urban population. Methods-Systematic chart abstraction was performed on consecutive hospitalized patients with ischemic stroke from all 7 acute care hospitals in the District of Columbia from February 1, 2008, to January 31, 2009. Results-Of 1044 patients with ischemic stroke, 74% were black, 19% non-Hispanic white, and 5% received intravenous tPA. Blacks were one third less likely than whites to receive intravenous tPA (3% versus 10%, P<0.001). However, blacks were also less likely than whites to present within 3 hours of symptom onset (13% versus 21%, P=0.004) and also less likely to be tPA-eligible (5% versus 13%, P<0.001). Of those who presented within 3 hours, blacks were almost half as likely to be treated with intravenous tPA than whites (27% versus 46%, P=0.023). The treatment rate for tPA-eligible patients was similar for blacks and whites (70% versus 76%, P=0.62). Conclusions-In this predominantly black urban population hospitalized for acute ischemic stroke, blacks were significantly less likely to be treated with intravenous tPA due to contraindications to treatment, delayed presentation, and stroke severity. Effective interventions designed to increase treatment in this population need to focus on culturally relevant education programs designed to address barriers specific to this population.
KW - African American
KW - acute stroke
KW - disparities
KW - race
KW - tPA
KW - thrombolytic therapy
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U2 - 10.1161/STROKEAHA.111.613828
DO - 10.1161/STROKEAHA.111.613828
M3 - Article
C2 - 21719765
AN - SCOPUS:79961208585
SN - 0039-2499
VL - 42
SP - 2217
EP - 2221
JO - Stroke
JF - Stroke
IS - 8
ER -