Racial disparities in tissue plasminogen activator treatment rate for stroke: A population-based study

Amie W. Hsia, Dorothy F. Edwards, Lewis B. Morgenstern, Jeffrey J. Wing, Nina C. Brown, Regina Coles, Sarah Loftin, Andrea Wein, Sara S. Koslosky, Sabiha Fatima, Brisa N. Sánchez, Ali Fokar, M. Chris Gibbons, Nawar Shara, Annapurni Jayam-Trouth, Stella Kidwell

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2217-2221
Number of pages5
JournalStroke
Volume42
Issue number8
DOIs
StatePublished - Aug 2011
Externally publishedYes

Fingerprint

Tissue Plasminogen Activator
Stroke
Population
Urban Population
Therapeutics
Education

Keywords

  • acute stroke
  • African American
  • disparities
  • race
  • thrombolytic therapy
  • tPA

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Hsia, A. W., Edwards, D. F., Morgenstern, L. B., Wing, J. J., Brown, N. C., Coles, R., ... Kidwell, S. (2011). Racial disparities in tissue plasminogen activator treatment rate for stroke: A population-based study. Stroke, 42(8), 2217-2221. https://doi.org/10.1161/STROKEAHA.111.613828

Racial disparities in tissue plasminogen activator treatment rate for stroke : A population-based study. / Hsia, Amie W.; Edwards, Dorothy F.; Morgenstern, Lewis B.; Wing, Jeffrey J.; Brown, Nina C.; Coles, Regina; Loftin, Sarah; Wein, Andrea; Koslosky, Sara S.; Fatima, Sabiha; Sánchez, Brisa N.; Fokar, Ali; Gibbons, M. Chris; Shara, Nawar; Jayam-Trouth, Annapurni; Kidwell, Stella.

In: Stroke, Vol. 42, No. 8, 08.2011, p. 2217-2221.

Research output: Contribution to journalArticle

Hsia, AW, Edwards, DF, Morgenstern, LB, Wing, JJ, Brown, NC, Coles, R, Loftin, S, Wein, A, Koslosky, SS, Fatima, S, Sánchez, BN, Fokar, A, Gibbons, MC, Shara, N, Jayam-Trouth, A & Kidwell, S 2011, 'Racial disparities in tissue plasminogen activator treatment rate for stroke: A population-based study', Stroke, vol. 42, no. 8, pp. 2217-2221. https://doi.org/10.1161/STROKEAHA.111.613828
Hsia, Amie W. ; Edwards, Dorothy F. ; Morgenstern, Lewis B. ; Wing, Jeffrey J. ; Brown, Nina C. ; Coles, Regina ; Loftin, Sarah ; Wein, Andrea ; Koslosky, Sara S. ; Fatima, Sabiha ; Sánchez, Brisa N. ; Fokar, Ali ; Gibbons, M. Chris ; Shara, Nawar ; Jayam-Trouth, Annapurni ; Kidwell, Stella. / Racial disparities in tissue plasminogen activator treatment rate for stroke : A population-based study. In: Stroke. 2011 ; Vol. 42, No. 8. pp. 2217-2221.
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abstract = "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.",
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T1 - Racial disparities in tissue plasminogen activator treatment rate for stroke

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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, Stella

PY - 2011/8

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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.

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KW - acute stroke

KW - African American

KW - disparities

KW - race

KW - thrombolytic therapy

KW - tPA

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