LOS ANGELES—Variables such as age, sex, race, and insurance status predict whether a patient with ischemic stroke will receive IV t-PA, according to an analysis presented at the 70th Annual Meeting of the American Academy of Neurology. The results provide “compelling evidence” of disparities, despite increased use of IV thrombolysis over time, said F. Stephen Benesh, MD, Chief Resident at the University of Alabama at Birmingham School of Medicine.
F. Stephen Benesh, MD
Stroke is the leading cause of mortality and morbidity in the United States and has an economic impact of more than $34 billion annually, said Dr. Benesh. IV t-PA has been available since the 1990s, but not all eligible patients have access to this treatment. Dr. Benesh and colleagues examined data from the National Inpatient Sample to find emerging trends and predictors of IV t-PA administration in the clinical setting.
The National Inpatient Sample is a stratified sample of all discharges from US community hospitals. The investigators analyzed data from 2003 through 2013 and identified 1,168,847 patients who had been discharged with a primary diagnosis of ischemic stroke. They ascertained whether patients had received thrombolytic infusion by looking at medical coding. A bimodal logistic regression analysis was performed to identify differences between patients who received t-PA and those who did not. Variables included age, sex, race, teaching status of the treating institution, and patient’s insurance type.
During the period examined, 3.2% of patients with ischemic stroke received thrombolytic treatment. The annual rate of IV t-PA administration increased during the period to approximately 6% in 2013.
Women were slightly more likely to receive IV t-PA than men (odds ratio [OR], 1.036). African Americans (OR, 0.884) were less likely than Caucasians to receive IV t-PA.
Patients insured with Medicare were less likely to receive t-PA than patients insured with Medicaid (OR, 1.128), patients with private insurance (OR, 1.216), and self-paying patients (OR, 1.162). Dr. Benesh and colleagues found no statistically significant difference in the rate of t-PA administration between patients with Medicaid, those with private insurance, and self-paying patients.
In addition, teaching hospitals were more likely than nonteaching hospitals to administer IV t-PA (OR, 1.685).
Various factors may account for the discrepancies in IV t-PA administration. For example, a recent study found that African Americans are more likely to refuse t-PA than patients of other ethnicities. This research reveals “ongoing problems with education and socioeconomic disparities,” said Dr. Benesh.
—Erik Greb