Procedure selection after stroke varies by race

Among patients with stroke, those of a minority race had higher odds than white patients of receiving life-sustaining procedures, but the reverse was true for carotid revascularization and procedures to improve functional status, according to a research letter published in JAMA Neurology.

Roland Faigle, MD, PhD, from the department of neurology at Johns Hopkins School of Medicine, and colleagues analyzed data from the Nationwide Impatient Sample of patients with ischemic stroke as the primary diagnosis (n = 340,463) between 2007 and 2011.

They assessed by race (white vs. any minority) the odds of undergoing life-sustaining procedures such as gastrostomy, tracheostomy, mechanical ventilation and hemicraniectomy; curative procedures to improve functional status such as IV thrombolysis; and carotid revascularization, including carotid stenting and endarterectomy.

The researchers reported that minority patients had higher rates of receiving lifesaving procedures than of not receiving them: 38.4% vs. 29.5% for gastrostomy; 48% vs. 29.8% for tracheostomy; 36.5% vs. 29.6% for mechanical ventilation, and 46.9% vs. 29.8% for hemicraniectomy (P < .001 for all).

Of those who received IV thrombolysis, 27.4% were of a minority race, whereas 30.3% of those not receiving IV thrombolysis were not white (P < .001). Of those who received carotid revascularization, 17.4% were minorities, but 24.6% of those not revascularized were minorities (P < .001), according to the researchers.

After multivariable adjustment, the researchers found that minority patients had higher odds than white patients of receiving gastrostomy (OR = 1.56; 95% CI, 1.48-1.65), tracheostomy (OR = 1.44; 95% CI, 1.3-1.56), mechanical ventilation (OR = 1.16; 95% CI, 1.09-1.24) and hemicraniectomy (OR = 1.36; 95% CI, 1.11-1.66).

However, according to the researchers, after adjustment, minority patients had lower odds of receiving IV thrombolysis (OR = 0.8; 95% CI, 0.75-0.86) and carotid revascularization (OR = 0.57; 95% CI, 0.5-0.66) than white patients.

“A better understanding of commonalities within and differences between life-sustaining procedures may facilitate the development of effective strategies aimed at eliminating racial disparities in the delivery of stroke care,” Faigle and colleagues wrote. – by James Clark

Disclosure: One researcher reports being an associate editor of JAMA Neurology.

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