Abstract TMP68: Vulnerability to Health Disparities and Secondary Stroke Prevention: The REGARDS Study
There are few studies on the effect of multiple vulnerabilities to health disparities identified in the AHRQ 2012 report on secondary stroke prevention. We examined the effects of 5 vulnerability domains (race, age, region, health insurance and income) on the prescription of secondary stroke prevention medications at discharge following hospitalization for an acute ischemic stroke (AIS) in a large, national cohort of patients admitted to unselected hospitals.
Methods: We conducted a retrospective review of admissions for AIS between 2003-2012 within the REGARDS cohort. Discharge medications, insurance status, and age at time of stroke event were obtained from hospital records. Race, region and income < $20,000 were obtained from REGARDS baseline data. We constructed a vulnerability score (v score) range from 0-5, with 0 indicating no vulnerability. We examined the prevalence of each discharge medication by each vulnerability domain, score category, and by overall score using Poisson regression with a robust variance estimator.
Results: 664 participants met the inclusion criteria. 132 (20%) of the study participants had ≥ 3 vulnerabilities (v score of 3-5). Participants with ≥ 3 vulnerabilities were more likely to be black (80.3%), > 75 years old (63.6%), and to report income < $20,000 (67.4%). The prevalence of receiving antithrombotic prescriptions at discharge was significantly lower in participants with ≥ 3 vulnerability domains (PR: 0.90 [95% CI: 0.82, 0.99]). The prevalence of receiving antithrombotic prescriptions was also inversely associated with a per point increase of the v score (PR: 0.96 [95% CI: 0.93, 0.99]), as were lipid- lowering prescriptions at discharge (PR: 0.95 [CI: 0.90, 0.99]). There was a non-statistically significant inverse association between ACEi/ARB prescriptions at discharge and having multiple vulnerabilities, including for 2 vulnerabilities (PR: 0.93 [CI: 0.80, 1.09]) and for ≥ 3 vulnerabilities (PR: 0.84 [CI: 0.69, 1.01]).
Conclusion: The presence of multiple vulnerabilities was associated with lower adherence by healthcare providers to secondary stroke prevention recommendations for discharge prescriptions.
Author Disclosures: J.D. Rhodes: None. A. Oikeh: None. C. Gamboa: None. A. Fadairo: None. S. Judd: None. V. Howard: None. M. Safford: None.
- © 2016 by American Heart Association, Inc.