Abstract TP400: Racial Differences in the Recovery from Ischemic Stroke after tPA.
Racial minorities are at a disadvantage with regards access to acute stroke therapies. We tested the hypothesis that differences between races would result in disparate recovery from ischemic stroke in patients who receive tPA. 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. Patients with self reported races: white, black and hispanic who received tPA for ischemic stroke were included. Outcomes of hospitalization including death and discharge destination were assessed. Racial subgroups by age and gender were also analyzed. In the NIS, 15,279 patients received tPA for ischemic stroke between 2001 and 2009. This included 75.3% white, 12.8% black and 6.3% hispanic. In-hospital death rates were not significantly different: 12.8% for white, 10.9% for black and 6.9% for Hispanic; p=0.07. Death rates remained similar even after adjustments for age. In-hospital death was also analyzed in racial subgroups of men, women, young(≤45), middle age (46-70) and elderly(>70); and there was no difference between races. Discharge destination was used as a surrogate for recovery. Blacks and hispanics had about 25% greater odds of being discharged home. However, when adjusted for age, there was no true difference between the races. Considering a home discharge or discharge to a short term rehabilitation facility as a good outcome, blacks were at a significant disadvantage compared to whites; age adjusted OR 0.88(0.80-0.98). This disparity was noted among black men only, and not in black women. As a minority, Hispanic patients had similar rates of home or rehabilitation discharge as whites. In conclusion, in-hospital death rates and the likelihood of home discharge were similar among races. The mechanisms driving disparate access to acute rehabilitation services among black men are probably biological and social. Reasons for differential access to tPA should be explored and addressed, as minorities receiving tPA have similar survival potential and likelihood for home discharge.
- © 2012 by American Heart Association, Inc.