Abstract P24: Ethnic Disparities in Acute Stroke Care in New York State

Abstract

Background: There is a greater burden of disease, mortality, and severity of strokes for Blacks and other ethnic minorities. Evidence for disparities in acute stroke care is less conclusive. Our goal was to assess whether significant ethnic disparities in acute stroke care exist in New York State (NYS). Methods: NYS Statewide Planning and Research Cooperative System (SPARCS) data was used to identify all patients from NYS with a principal diagnosis of acute ischemic stroke (AIS, ICD-9 Diagnosis code of 433.01, 433.11, 433.21, 433.31, 433.91, 434.01, 434.11, or 434.91) from 1-1-2007 through 12-31-2008. Data were analyzed by chi square with respect to race/ethnicity (White, Black, or Hispanic), discharge from a NYS designated Primary Stroke Center (PSC), and use of intravenous t-PA. Get With The Guidelines preliminary data was used to examine the relationship between ethnicity and percent of AIS patients arriving < 2 hours, and percent arriving < 2 hours who were eligible for t-PA for whom t-PA was initiated < 3 hours. Results: There were 47,037 patients with AIS, including 28,628 Whites, 4,166 Hispanics, and 9,001 Blacks. Whites were treated at PSCs 75% (21,489 of 28,628) of the time, compared to 91% (3,786 of 4,166) of Hispanics (p < 0.0001) and 85% (7,620 of 9,001) of Blacks (p < 0.0001). Overall, 4.7% (1,737 of 37,162) of AIS patients at PSCs were treated with t-PA compared to 1.4% (143 of 9,875) of patients treated elsewhere (p < 0.0001). Whites at PSCs received t-PA 5.2% (1,119 of 21,489) of the time, compared to 4.2% (160 of 3,786) of Hispanics (p = 0.01 vs. Whites), and 3.5% (267 of 7,620) of Blacks (p < 0.0001 vs. Whites). Whites arrived within 2 hours 48% (5,762 of 12,016) of the time, compared to 45% (815 of 1,792) of Hispanics (p < 0.001) and 44% (1,096 of 2,479) of Blacks (p <0.001). Eligible White patients were treated with t-PA 71% (864 of 1,216) of the time, compared to 70% (133 of 191) of Hispanics (p = NS) and 62% (164 of 265) of Blacks (p = 0.03). Conclusions: Access to care does not guarantee utilization, particularly for Blacks. Black and Hispanic AIS patients were more often treated at PSCs compared to Whites. Yet, a lower percent of Blacks and Hispanics were treated with t-PA, reflecting both lower rates of timely hospital arrival and less frequent treatment of eligible patients.