Abstract TMP21: The Increased tPA Utilization in Recent Years has Disproportionately Benefited White Men.
Intravenous tPA utilization has increased in the United States across the last decade. Gender disparities in tPA use are recognized. While blacks are at a disadvantage with regards to tPA use, little is known about stroke care among hispanic patients. We tested the hypothesis that the rise in tPA utilization differentially affected race and gender subgroups. Data from the Nationwide Inpatient Sample (NIS) for the years 2001 through 2009 were analyzed. The data represents a 20% sample of all inpatient hospitalizations in the United States. Patients discharged with a diagnosis of Ischemic stroke were identified using ICD-9 codes. The code 99.10 was used to identify patients who received tPA. Trends in utilization were compared between race and gender subgroups. The NIS had 1,003,533 ischemic stroke discharges over 9 years. Race data was available in 757,238 patients. All races demonstrated significant increase in tPA utilization between 2001 and 2009: 1.15% to 4% among whites; 0.83% to 3.30% among blacks and 0.72% to 2.91% among hispanic (p for trend<0.0001).Upon comparing race and gender subgroups (Fig) tPA utilization was greatest in white men. White women, black men, black women and hispanic women consistently fared worse with regards to tpa utilization when compared with white men. During most years, black and hispanic women demonstrated the lowest rates of tPA utilization. Even in urban teaching hospitals, white men demonstrated the greatest rise in tPA utilization (1.72% to 6.24%), while the use in minority women remained significantly lower. Disparities in race and gender subgroups were mainly in patients older than 45 years. In conclusion, the rise in tPA utilization in the last decade was greatest among white men and lowest among minority women. Social and cultural factors putting minority women at a disadvantage need to be explored and addressed.
- © 2012 by American Heart Association, Inc.