Published Online
on March 20, 2003

A more recent version of this article appeared on April 1, 2003

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Submitted on October 16, 2002
Accepted on October 30, 2002

Veterans Administration Acute Stroke (VASt) Study. Lack of Race/Ethnic-Based Differences in Utilization of Stroke-Related Procedures or Services

Larry B. Goldstein MD^*; David B. Matchar MD; Jennifer Hoff-Lindquist MS; Gregory P. Samsa PhD; and Ronnie D. Horner PhD

From the Durham Veterans Affairs Medical Center, Durham, NC (L.B.G., D.B.M., J.H-L.); Departments of Neurology (L.B.G.) and General Internal Medicine (D.B.M., G.P.S.), Department of Medicine; Stroke Policy Program, Center for Clinical Health Policy Research (L.B.G., D.B.M.); and Center for Cerebrovascular Disease (L.B.G., D.B.M., G.P.S.), Duke University, Durham, NC; and Office of Minority Health and Research, National Institute of Neurological Disorders and Stroke, Bethesda, Md (R.D.H.).

^* To whom correspondence should be addressed. E-mail: golds004{at}mc.duke.edu.

Background and Purpose--Race/ethnic-based disparities in the utilization of health-related services have been reported. Data collected as part of the Veterans Administration Acute Stroke Study (VASt) were analyzed to determine whether similar differences were present in patients admitted to Veterans Administration (VA) hospitals with acute ischemic stroke.

Methods--VASt prospectively identified stroke patients admitted to 9 geographically separated VA hospitals between April 1995 and March 1997. Demographic characteristics and all inpatient diagnostic tests/procedures were recorded. Frequencies were compared with ² tests.

Results--Of 1073 enrolled patients, 775 (white, n=520; nonwhite, n=255, including 226 blacks and 28 Hispanic-Americans) with ischemic stroke were admitted from home. Mean ages (71.0±0.6 versus 71.9±0.4 years; P=0.25) and Trial of ORG 10172 in Acute Stroke Treatment (TOAST) stroke types (atherothrombotic, 12.9% versus 13.3%; cardioembolic, 16.5% versus 18.0%; lacunar, 26.4% versus 27.1%; other, 1.4% versus 2.0%; unclassified, 42.9% versus 39.6%; P=0.89) for whites versus nonwhites were similar. There were no race/ethnic-based differences in the utilization of brain CT (91.0% versus 92.2%; P=0.58), MRI (36.2% versus 41.6%; P=0.14), transthoracic (52.5% versus 53.7%; P=0.75) or transesophageal echocardiography (10.2% versus 10.6%; P=0.86), 24-hour ECG (3.3% versus 1.6%; P=0.17), carotid ultrasound (64.0% versus 62.0%; P=0.57), carotid endarterectomy (1.5% versus 0.8%; P=0.38), rehabilitation evaluations (71.0% versus 76.5%; P=0.11), speech therapy (9.6% versus 12.6%; P=0.21), recreational therapy (3.1% versus 2.0%; P=0.37), or occupational therapy (16.0% versus 19.6%; P=0.20) for whites versus nonwhites, respectively. Angiography was performed less frequently (3.1% versus 8.5%; P=0.01) and ECG more frequently (81.6% versus 73.5%; P=0.01) in nonwhites. The proportions of patients discharged functionally independent were also similar (52% of whites and 50% of nonwhites had discharge Rankin Scale scores of 0, 1, or 2; P=0.63).

Conclusions--Aside from cerebral angiography and ECG, there were no race/ethnic-based disparities in the utilization of a variety of stroke-related procedures and services. The difference in the use of angiography is unlikely to be related to a difference in screening for carotid endarterectomy because there was no difference in the frequency of carotid ultrasonography. The reason ECG was obtained more frequently in nonwhites is uncertain.

Key words: health services • racial differences • stroke

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