Asian Americans With Ischemic Stroke Have Worse Outcomes Than White Patients

Asian American patients with acute ischemic stroke experience more severe ischemic strokes, have a lower likelihood of receiving intravenous tissue plasminogen activator (tPA), and have worse functional outcomes when compared with white patients with ischemic stroke, according to study results published in JAMA Neurology.

Investigators retrospectively collected data of Asian American (n=64,337) and white patients (n=1,707,962) with acute ischemic stroke who were admitted to 2171 hospitals participating in the Get With the Guidelines-Stroke (GWTG-Stroke) program between 2004 and 2016. Various performance measures were assessed, including deep vein thrombosis prophylaxis and onset to tPA by 3 hours in patients with hospital arrival within 2 hours, and multivariable adjusted analyses were performed to evaluate the association among race/ethnicity, clinical outcomes, and quality measures.

In the adjusted analysis, Asian American patients had greater stroke severity compared with white patients (National Institutes of Health Stroke Scale score ≥16; odds ratio [OR] 1.35; 95% CI, 1.30-1.40; P <.001). In addition, Asian Americans had higher in-hospital mortality (OR 1.14; 95% CI, 1.09-1.19; P <.001) and longer length of hospital stay (OR 1.17; 95% CI, 1.14-1.20; P <.001), and were less likely to ambulate on their own at discharge (OR 0.84; 95% CI, 0.79-0.90; P <.001).

American patients of Asian descent also had fewer intravenous tPA administrations than white patients (OR 0.95; 95% CI, 0.91-0.98; P =.003), greater post-tPA symptomatic hemorrhage (OR 1.36; 95% CI, 1.20-1.55; P <.001), and more overall complications after tPA (OR 1.31; 95% CI, 1.18-1.46; P <.001). Quality measure adherence was better in Asian Americans, including rehabilitation (OR 1.27; 95% CI, 1.18-1.36; P <.001), door to tPA ≤60 minutes (OR 1.14; 95% CI, 1.06-1.22; P <.001), and intensive statin therapy (OR 1.14; 95% CI, 1.10-1.18; P <.001). Finally, after adjusting for stroke severity, Asian Americans had lower in-hospital mortality compared with white patients (OR 0.95; 95% CI, 0.91-0.99; P =.008).

The voluntary nature of participation in the GWTG-Stroke program may have included only hospitals with higher care, which may limit the generalizability of the study’s results.

“Further research is necessary to better define interventions that can improve the disparities that Asian American patients experience in acute ischemic stroke,” the researchers wrote.

Reference

Song S, Liang L, Fonarow GC, et al. Comparison of clinical care and in-hospital outcomes of Asian American and white patients with acute ischemic stroke [published online January 22, 2019]. JAMA Neurol. doi: 10.1001/jamaneurol.2018.4410