Abstract WP73: Impact Of Patient Age On Sex Disparities In Intravenous Alteplase Administration For Acute Ischemic Stroke

Abstract

Background: Prior research with the National Inpatient Sample (NIS) has shown that women are less likely than men to receive to receive intravenous Alteplase (tPA) for acute ischemic stroke, but more recent analyses have found conflicting results and patient age has not been taken into account, nor has stroke severity. Methods: We included patients in the NIS from 2016-18 with a primary discharge diagnosis of ischemic stroke and who had an admission NIH Stroke Scale (NIHSS). The primary outcome was receipt of tPA and the exposure was patient sex. After survey weighting, we fit logistic regression models adjusted for age, race/ethnicity, NIHSS, patient income by ZIP code, hospital teaching status, hospital Census region, and hospital location according to the NCHS Urban-Rural Classification. We included interactions between our covariates and the exposure of sex. Results: After weighting, we included 384,700 patients, of which 15.1% received tPA and 49.1% were female. The rate of tPA was identical (15.1%) between male and female patients (p=0.880). In the multivariable logistic regression model, female sex had an odds ratio for tPA of 0.97 (95% CI 0.93, 1.01, p=0.163). The only covariate that had a significant interaction with sex was age (p<0.001 for interaction). After stratification, female patients aged ≥75 were 1.5% (95% CI -2.3, -0.7, p<0.001) less likely than men to receive tPA (Figure 1). Conclusion: In the most recent sample of the NIS, women with acute ischemic stroke are no longer less likely than men to receive tPA. We show this holds true after adjustment for stroke severity, although there is still a disparity in older patients aged ≥75, with women being 1.5% less likely than men to receive tPA.