Sex and racial disparity in utilization and outcomes of t-PA and thrombectomy in acute ischemic stroke

Abstract

Background/purpose: Racial/ethnic and sex disparity may occur in stroke throughout the continuum of care. Endovascular therapy (EVT) became standard of care in 2015 for eligible patients with acute ischemic stroke (AIS). We evaluated for racial and sex differences in t-PA and EVT utilization and outcomes in 2016 in the National Inpatient Sample. Methods: Treatment rates for t-PA, EVT, and t-PA+EVT and outcomes including home discharge, in-hospital mortality and prolonged length of stay (pLOS) were evaluated by sex and race. Multivariate survey-logistic regression was performed to evaluate outcomes. ResultsThe study had 468,630 patients – 49.3% men, 50.7% women; 69.3% whites, and 30.7% non-whites. There was no difference in treatment utilization by sex, women vs men for t-PA (7.65% vs 7.76%; aOR:1.02; 95% CI:0.97–1.07), EVT (1.74% vs 1.67%; aOR:1.09; 95% CI:0.99–1.20) and t-PA+EVT (0.57% vs 0.57%; aOR:1.01; 95% CI:0.85–1.21); and by race, non-white vs white for t-PA (7.62% vs 7.74%; aOR:0.98; 95% CI:0.93–1.05), EVT (1.62% vs 1.74%; aOR:0.91; 95% CI:0.78–1.07), and t-PA+EVT(0.59% vs 0.56%; aOR:1.05; 95% CI:0.84–1.30). Compared to men, women treated with t-PA had less home discharge (37.2% vs 46.3%; aOR:0.81; 95% CI:0.72–0.90), more in-hospital mortality (5.7% vs 3.9%; aOR:1.37; 95% CI:1.06–1.77) and less pLOS (8.3% vs 9.6%; aOR:0.82; 95% CI:0.69–0.98); women treated with EVT had less home discharge (15.8% vs 23.7%; aOR:0.69; 95% CI:0.52-0.91). Compared to whites, non-whites treated with t-PA had lower odds of home discharge (42.1% vs 41.6%; aOR:0.79; 95% CI:0.69–0.90), less in-hospital mortality (3.7% vs 5.3%; aOR:0.65; 95% CI:0.49–0.87), and higher pLOS (11.4% vs 7.9%; aOR:1.3; 95% CI:1.07–1.56); non-whites treated with EVT had less home discharge (18%vs 20.2%; aOR:0.70; 95% CI:0.51–0.97) and higher pLOS (35.1% vs 24%; aOR:1.52; 95% CI:1.16–1.99). Conclusion: Sex and racial disparity exists for outcomes of t-PA and EVT despite no difference in utilization rates.