Geographic and Regional Variability in Racial and Ethnic Disparities in Stroke Thrombolysis in the United States. Issue 12 (December 2021)

• Record Type: Journal Article
• Authors: Suolang, Deji; Chen, Bridget J.; Wang, Nae-Yuh; Gottesman, Rebecca F.; Faigle, Roland
• Is Part Of: Stroke. Volume 52:Issue 12(2021)
• Publication Date: 2021-12
• Subjects: African Americans -- ethnic groups -- geographic locations -- minority groups -- stroke -- thrombolytic therapy; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.121.035220
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose: Intravenous thrombolysis (IVT) after ischemic stroke is underutilized in racially/ethnically minoritized groups. We aimed to determine the regional and geographic variability in racial/ethnic IVT disparities in the United States. Methods: Acute ischemic stroke admissions between 2012 and 2018 were identified in the National Inpatient Sample. Multivariable logistic regression was used to test the association between IVT and race/ethnicity, stratified by geographic region and controlling for demographic, clinical, and hospital characteristics. Results: Of the 545 509 included cases, 47 031 (8.6%) received IVT. Racially/ethnically minoritized groups had significantly lower adjusted odds of IVT compared with White people in the South Atlantic region (odds ratio [OR], 0.86 [95% CI, 0.82–0.91]), the East North Central region (OR, 0.91 [95% CI, 0.85–0.97]) and the Pacific region (OR, 0.90 [95% CI, 0.85–0.96]). In the South Atlantic region, IVT use in racial/ethnic minority groups was below the national average of all racial/ethnic minority patients ( P =0.002). Compared with White patients, Black patients had lower odds of IVT in the Middle Atlantic region (OR, 0.84 [95% CI, 0.78–0.91]), the South Atlantic region (OR, 0.78 [95% CI, 0.74–0.82]), and the East North Central region (OR, 0.86 [95% CI, 0.79–0.93]). In the South Atlantic region, this difference was below the national average for Black people ( P <0.001). Hispanic patients had significantly lower use of IVT only in the Pacific region (OR, 0.92 [95% CI, 0.85–0.99]), while Asian/Pacific Islander patients had lower odds of IVT in the Mountain (OR, 0.76 [95% CI, 0.59–0.98]) and Pacific region (OR, 0.89 [95% CI, 0.82–0.97]). Conclusions: Racial/ethnic disparities in IVT use in the United States vary by region. Geographic hotspots of lower IVT use in racially/ethnically minoritized groups are the South Atlantic region, driven predominantly by lower use of IVT in Black patients, and the East North Central and Pacific regions. Abstract : Supplemental Digital Content is available in the text.