This Article Full Text Full Text (PDF) All Versions of this Article: 34/4/999    most recent 01.STR.0000063364.88309.27v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goldstein, L. B. Articles by Kenton, E. J. Search for Related Content PubMed PubMed Citation Articles by Goldstein, L. B. Articles by Kenton, E. J., III Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Health policy and outcome research Secondary prevention Other diagnostic testing Acute Cerebral Infarction

(Stroke. 2003;34:999.)
© 2003 American Heart Association, Inc.

Original Contributions

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 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.).

Correspondence to Larry B. Goldstein, MD, Duke Center for Cerebrovascular Disease, Stroke Policy Program, Center for Clinical Health Policy Research, Box 3651, Duke University Medical Center, Durham, NC 27710. 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.

Diagnostic Disparities: Still Exist?

Edgar J. Kenton, III, MD, Guest Editor

This article has been cited by other articles:

				A. Gunarathne, J. V. Patel, B. Gammon, P. S. Gill, E. A. Hughes, and G. Y.H. Lip Ischemic Stroke in South Asians: A Review of the Epidemiology, Pathophysiology, and Ethnicity-Related Clinical Features Stroke, June 1, 2009; 40(6): e415 - e423. [Abstract] [Full Text] [PDF]

				D. Kleindorfer Sociodemographic Groups at Risk: Race/Ethnicity Stroke, March 1, 2009; 40(3_suppl_1): S75 - S78. [Full Text] [PDF]

				B. S. Jacobs, G. Birbeck, A. J. Mullard, S. Hickenbottom, R. Kothari, S. Roberts, and M. J. Reeves Quality of hospital care in African American and white patients with ischemic stroke and TIA Neurology, March 28, 2006; 66(6): 809 - 814. [Abstract] [Full Text] [PDF]

				M. A. Smith, L. D. Lisabeth, D. L. Brown, and L. B. Morgenstern Gender comparisons of diagnostic evaluation for ischemic stroke patients Neurology, September 27, 2005; 65(6): 855 - 858. [Abstract] [Full Text] [PDF]

				J. P. Stansbury, H. Jia, L. S. Williams, W. B. Vogel, and P. W. Duncan Ethnic Disparities in Stroke: Epidemiology, Acute Care, and Postacute Outcomes Stroke, February 1, 2005; 36(2): 374 - 386. [Abstract] [Full Text] [PDF]

				A. D. Gurmankin, D. Polsky, and K. G. Volpp Accounting for Apparent "Reverse" Racial Disparities in Department of Veterans Affairs (VA)-Based Medical Care: Influence of Out-of-VA Care Am J Public Health, December 1, 2004; 94(12): 2076 - 2078. [Abstract] [Full Text] [PDF]