Use of reperfusion therapy and time delay in patients with ischaemic stroke by immigration status: A register‐based cohort study in Denmark. (9th March 2022)

• Record Type: Journal Article
• Authors: Mkoma, George F.; Norredam, Marie; Iversen, Helle K.; Andersen, Grethe; Johnsen, Søren P.
• Is Part Of: European journal of neurology. Volume 29:Number 7(2022)
• Page Start: 1952
• Page End: 1962
• Publication Date: 2022-03-09
• Subjects: immigration -- ischaemic stroke -- prehospital delay -- reperfusion therapy -- system delay; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.8
• DOI: 10.1111/ene.15303
• Languages: English
• ISSNs: 1351-5101

Abstract

Abstract: Background and purpose: Reperfusion therapy is the mainstay of treatment for acute ischaemic stroke (AIS); however, little is known about the use of reperfusion therapy and time delay amongst immigrants. Methods: This is a Danish nationwide register‐based cohort study of patients with AIS aged ≥18 years ( n = 49, 817) recruited from 2009 to 2018. Use of reperfusion therapy (intravenous thrombolysis and/or mechanical thrombectomy) and time delay between immigrants and Danish‐born residents were compared using multivariable logistics and quantile regression. Results: Overall, 10, 649 (39.8%) Danish‐born residents and 452 (39.0%) immigrants with AIS were treated with reperfusion therapy in patients arriving <4.5 h following stroke onset. Compared with Danish‐born residents, immigrants had lower odds of receiving reperfusion therapy after adjustment for prehospital delay, age, sex, stroke severity, sociodemographic factors and comorbidities (adjusted odds ratio 0.67; 95% confidence interval 0.49‒0.92, p = 0.01). The lowest odds were observed amongst immigrants originating from Poland and non‐Western countries. Similarly, immigrants had a longer prehospital delay than Danish‐born residents in the fully adjusted model in patients arriving <4.5 h after stroke onset (15 min; 95% confidence interval 4‒26 min, p = 0.03). No evidence was found that system delay and clinical outcome differed between immigrants and Danish‐born residents in patients eligible for reperfusion therapy after adjustment for sociodemographic factors and comorbidities. Conclusion: Immigration status was significantly associated with lower chances of receiving reperfusion therapy and there may be differences in patient delay between immigrants and Danish‐born residents in patients arriving to a stroke unit <4.5 h after stroke onset. Abstract : In this cohort study from 2009 to 2018, which included 49, 817 patients with acute ischaemic stroke, it was observed that immigrants had significantly lower chances of receiving reperfusion therapy than Danish‐born residents. No difference in system‐related time delays and clinical outcome between immigrants and Danish‐born residents in patients eligible for reperfusion therapy was found; however, there may be differences in patient delay amongst individuals arriving at a stroke unit within 4.5 h after stroke onset.