Racial disparities in tissue plasminogen activator treatment rate for stroke: a population-based study.
Racial disparities in tissue plasminogen activator treatment rate for stroke: a population-based study.
复制标题
DOI：
10.1161/strokeaha.111.613828
复制
发表时间：
2011-08
期刊：
影响因子：
8.3
通讯作者：
Kidwell CS
中科院分区：
文献类型：
--
作者：
Hsia AW;Edwards DF;Morgenstern LB;Wing JJ;Brown NC;Coles R;Loftin S;Wein A;Koslosky SS;Fatima S;Sánchez BN;Fokar A;Gibbons MC;Shara N;Jayam-Trouth A;Kidwell CS
一些既往研究表明，急性缺血性卒中患者静脉注射组织纤溶酶原激活剂（IV tPA）存在种族差异。我们试图确定在以黑人为主的城市人群中，种族是否与tPA治疗卒中相关。从2008年2月1日至2009年1月31日，对来自哥伦比亚特区所有7家急诊医院的连续住院缺血性卒中患者进行系统图表提取。在1044例缺血性卒中患者中，74%为黑人，19%为非西班牙裔白色人，5%接受了IV tPA治疗。黑人接受IV tPA的可能性比白人低三分之一（3%对10%，p<0.001）。然而，黑人在症状发作后3小时内出现的可能性也低于白人（13% vs. 21%，p=0.004），并且符合tPA资格的可能性也低于白人（5% vs. 13%，p<0.001）。在3小时内就诊的患者中，黑人接受IV tPA治疗的可能性几乎是白人的一半（27% vs. 46%，p=0.023）。黑人和白人的tPA合格患者的治疗率相似（70% vs. 76%，p=0.62）。在因急性缺血性卒中住院的主要为黑人的城市人群中，由于治疗禁忌症、延迟就诊和卒中严重程度，黑人接受IV tPA治疗的可能性显著降低。旨在增加这一人群治疗的有效干预措施需要关注旨在解决这一人群特有障碍的文化相关教育计划。
Some prior studies have shown that racial disparities exist in intravenous tissue plasminogen activator (IV tPA) utilization for acute ischemic stroke. We sought to determine whether race was associated with tPA treatment for stroke in a predominantly black urban population. Systematic chart abstraction was performed on consecutive hospitalized ischemic stroke patients from all seven acute care hospitals in the District of Columbia from Feb 1, 2008 to Jan 31, 2009. Of 1044 ischemic stroke patients, 74%% were black, 19% non-Hispanic white, 5% received IV tPA. Blacks were one third less likely than whites to receive IV tPA (3% vs. 10%, p<0.001). However, blacks were also less likely than whites to present within 3 hours of symptom onset (13% vs. 21%, p=0.004) and also less likely to be tPA-eligible (5% vs. 13%, p<0.001). Of those who presented within 3 hours, blacks were almost half as likely to be treated with IV tPA than whites (27% vs. 46%, p=0.023). The treatment rate for tPA-eligible patients was similar for blacks and whites (70% vs. 76%, p=0.62). In this predominantly black urban population hospitalized for acute ischemic stroke, blacks were significantly less likely to be treated with IV tPA due to contraindications to treatment, delayed presentation, and stroke severity. Effective interventions designed to increase treatment in this population need to focus on culturally relevant education programs designed to address barriers specific to this population.