Between 2009 and 2018 there was a significant improvement in racial and ethnic disparities in intravenous thrombolysis use after stroke in the US, according to study results published as a letter in the Journal of the American Medical Association (JAMA).
Previous studies reported lower rates of intravenous thrombolysis use after stroke in Black and Hispanic individuals in the US. The objective of the current study was to assess the temporal trends in stroke thrombolysis in the US by race and ethnicity between 2009 and 2018.
Using data from the 2009-2018 National Inpatient Sample, patients hospitalized for ischemic stroke were identified and proportions and percentages of intravenous thrombolysis use by race and ethnicity and year were calculated.
The study included 752,369 ischemic stroke discharges (median age, 72 years; 51.9% women; 68.9% White). The use of intravenous thrombolysis increased between 2009 and 2018 among patients who were White (from 4.6% to 10.9%), Hispanic (from 3.2% to 12.3%), and Black (from 3.7% to 10.2%).
Over the 10-year period, rates of intravenous thrombolysis were lower among individuals from all racial and ethnic minorities, compared with White patients (adjusted odds ratio [OR], 0.90; 95% CI, 0.88-0.93). However, the gap between individuals from all racial and ethnic minorities combined with White individuals decreased significantly between 2009 (adjusted OR, 0.81; 95% CI, 0.70-0.93) and 2018 (adjusted OR, 0.95; 95% CI, 0.89-1.02) (P =.001 for interaction of race and ethnicity with year) and became statistically non-significant by 2018.
The gap with White individuals was narrowed for Black individuals (adjusted OR, 0.91; 95% CI, 0.82-1.00) and disappeared entirely for Hispanic individuals (adjusted OR, 1.08; 95% CI, 0.99-1.18) by 2014.
One of the main limitations of the study was the lack of information on clinical stroke characteristics, medications, and thrombolysis eligibility and contraindications.
“This study found that racial and ethnic disparities in IV thrombolysis use after stroke improved between 2009 and 2018, with the gap with White individuals narrowing for Black individuals and disappearing for Hispanic individuals. Potential reasons may include effectiveness of efforts to reduce stroke disparities and the increasing organization of stroke care,” concluded the researchers.
Suolang D, Chen BJ, Wang NY, et al. Temporal trends in stroke thrombolysis in the US by race and ethnicity, 2009-2018. JAMA. Published online October 11, 2021. doi: 10.1001/jama.2021.12966