Abstract
Introduction: In Hawaii, Filipinos have the highest stroke mortality for unclear reasons. The objective of this study is to elucidate racial-ethnic differences in the use of antithrombotics and statins upon discharge home from hospitalization among stroke survivors. Methods: The Get With the Guidelines-Stroke (GWTG-Stroke) data from January 2010 to December 2016 at the only Comprehensive Stroke Center in Hawaii was retrospectively reviewed. Subjects with non-ischemic stroke and with disposition other than home were excluded. Multivariable logistic regression models examined differences in appropriate medication use at discharge related to race/ethnicity compared with whites after adjusting for age, sex, insurance status, prior medication use and stroke risk factors. Results: Among a total of 2347 patients studied (621 (26%) whites (W), 302 (13%) Filipinos (FI), 838 (36%) other Asians (OA), 538 (23%) Native Hawaiians and other Pacific Islanders (NHOPI), and 48 (2%) other race (O)), FI were prescribed less antithrombotic agents at discharge [OR 0.56; 95% CI 0.380, 0.837] than W, while there were no racial-ethnic differences among OA, NHOPI and O compared to W. Age [OR 1.02; 95% CI 1.006, 1.03], prior antithrombotic use [OR 2.04, 95% CI 1.47, 2.82] and coronary artery disease/prior myocardial infarction [OR 2.04, 95% CI 1.23, 3.39] were also independent predictors of antithrombotic prescription upon discharge. For statin prescription upon discharge, there was no difference between FI and W. NHOPI race [OR 2.09; 95% CI 1.54, 2.83], age [OR 1.01, 95% CI 1.001, 1.02], female sex [OR 0.68; 95% CI 0.55, 0.84], prior anti-cholesterol medication use [OR 4.12, 95% CI 3.01 5.63], dyslipidemia [OR 1.91, 95% CI 1.47, 2.49] and carotid stenosis [OR 0.49, 95% CI 0.32, 0.74] were predictors of statin prescription upon discharge. Conclusions: Filipinos are less likely to be prescribed an antithrombotic for stroke prevention compared with whites after hospitalization for stroke.
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