Kevin O’Connor, MD
Suolang D, Chen BJ, Wang NY, Gottesman RF, Faigle R. Geographic and Regional Variability in Racial and Ethnic Disparities in Stroke Thrombolysis in the United States. Stroke. 2021;52:e782–e787.
Disparities in the administration of IV thrombolysis (IVT) have previously been reported, but Suolang et al. report regional disparities in the administration of IVT based on race/ethnicity. They examined IVT administration in 47,031 (8.6%) of 545,509 patients diagnosed with acute ischemic stroke between 2012 and 2018 according to nine United States Census Bureau regions (see Figure 2B below). Race/ethnic groups comprised White, Black, Hispanic, Asian/Pacific Islander, as well as Native American and Other.
Minority groups, as a whole, were less likely to receive IVT compared to White people in the South Atlantic (odds ratio [OR], 0.86 [95% CI, 0.82–0.91]), East North Central (OR, 0.91 [95% CI, 0.85–0.97]), and Pacific regions (OR, 0.90 [95% CI, 0.85–0.96]). The disparity in the South Atlantic region for all minority groups was significantly lower than that of the United States as a whole (OR, 0.86 [95% CI, 0.82–0.91]) vs (OR, 0.93 [95% CI, 0.90-0.95]; P=0.002).
The authors found disparities in administration of IVT between White patients and Asian/Pacific Islander, Black, and Hispanic patients in different regions. Asian/Pacific Islander patients were less likely to receive IVT in the Mountain (OR, 0.76 [95% CI, 0.59–0.98]) and Pacific (OR, 0.89 [95% CI, 0.82–0.97]) regions compared to White patients. Although Hispanic patients had lower odds of IVT than White patients (OR, 0.92 [95% CI, 0.85–0.99]) in the Pacific region, they had higher odds of IVT in the South Atlantic (OR, 1.15 [95% CI, 1.04-1.28]) and West South Central (OR, 1.15 [95% CI, 1.06-1.29]) regions. Compared to White patients, Black patients had lower odds of IVT in the Middle Atlantic (OR, 0.84 [95% CI, 0.78–0.91]), South Atlantic (OR, 0.78 [95% CI, 0.74–0.82]), and East North Central regions (0.86 [95% CI, 0.79–0.93]).
There should be no difference in the administration of IVT among racial and ethnic groups in the United States. Suolang et al. provide data on the existence of racial/ethnic disparities regarding IVT, but additional studies may reveal finer geographic differences in the provision of stroke care or disparities in other aspects of stroke care. Efforts to alleviate the impact of the regional disparities in stroke care will require identifying, acknowledging, and addressing underlying systemic barriers that disproportionately affect minority groups. Some of these efforts may include tailored approaches to increase the health literacy of minority groups and to improve their access to healthcare resources. These efforts should also include regional approaches to changing healthcare provider practice habits that result in disparities.