Abstract Details

Title The Increased tPA Utilization over the Years Disproportionately Benefited White Men

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 218

Objective

Background BACKGROUND: 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.

Design/Methods DESIGN/METHODS: 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.

Results RESULTS: 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 tPA utilization was greatest in white men. White women, black men, black women and hispanic women consistently fared significantly 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. Within urban teaching hospitals also, white men demonstrated the greatest rise in tPA utilization (1.72% to 6.24%), while the use in minority women remained significantly low. Disparities in race and gender subgroups were mainly in patients older than 45 years.

Conclusions CONCLUSIONS: 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 corrected.

Authors/Disclosures
Pratik D. Bhattacharya, MD, MPH (International Medical Clinic) PRESENTER	Dr. Bhattacharya has a non-compensated relationship as a Research Advisor with Defeat MSA Alliance 501 (c) (3) that is relevant to AAN interests or activities.
Seemant Chaturvedi, MD, FAHA, FAAN (University of Maryland)	Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Chaturvedi has received research support from NINDS.
Greg Mytyk (University of Tennessee)	No disclosure on file

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