Abstract Body: Introduction: Studies of racial and ethnic disparities in using intravenous thrombolytics (IVT) for stroke in large healthcare systems and specific US states are lacking. This study examines potential contributors to disparities in IVT administration in a large Western healthcare system overall and by state (AK, CA, OR, TX and WA).
Methods: This retrospective analysis of a systemwide stroke registry analyzed patients with ischemic stroke admitted January 2016 to September 2023. Patients aged <18 years, those arriving >4.5 hours from last known well (LKW), those with stroke occurring post hospital arrival and those receiving endovascular treatment were excluded. Generalized linear models were used to assess whether some racial and ethnic patient groups were less likely to receive IVT vs White patients, adjusting for age, National Institutes of Health Stroke Scale score at admission, LKW to arrival time, previous stroke, atrial fibrillation/flutter, obesity, mode of arrival, door-to–computed tomography scan time, insurance status and facility certification status.
Results: Among 16,833 patients included, 45.0% received IVT. Overall, Black patients were less likely to receive IVT vs White patients (Table 1), but this was not significant. By state, Black patients were less likely to receive IVT vs White patients in OR and WA (Table 1). While Black and White patients had similar LKW to arrival times, Black patients were younger, had more severe strokes and used emergency medical service (EMS) at higher rates vs White patients (Table 2). Compared with White patients, American Indian/Alaska Native patients were younger and used EMS at higher rates. Hispanic/Latino and Native Hawaiian/Pacific Islander patients were also younger and had more severe strokes than White patients.
Conclusions: These data suggest that racial and ethnic disparities in stroke treatment vary by geography within a large healthcare system. Further analyses into the underlying factors are needed to guide tailored education at the local level.