Are There Disparities in Thrombolytic Treatment and Mortality in Acute Ischemic Stroke in the Hispanic Population Living in Border States versus Nonborder States?

BACKGROUND: Recent studies have found an underutilization of hospital in-patient care for coronary artery disease in Hispanics living in border states.

OBJECTIVE: To identify acute treatment disparities in acute ischemic stroke Hispanic patients and determine the effect of such disparity on patient outcomes.

METHODS: We identified Hispanic and non-Hispanic acute ischemic stroke patients from the Nationwide Inpatient Sample-2011 data files. We determined the rate of utilization of thrombolytics and outcomes according to patient's demographic and clinical characteristics and whether or not they lived in a border state (defined as California, Arizona, New Mexico, and Texas).

RESULTS: A total of 34,904 Hispanic patients were admitted with ischemic stroke; of those 21,130 were admitted in border states and 13,774 in nonborder states. There was a significantly lower rate of thrombolytic use in Hispanic patients (1013 (4.8%) and non-Hispanics (5326 (5.7%, p=0.05)). After adjusting for age, gender, and other confounding risk factors, Hispanics were 30% more likely to suffer in-hospital mortality versus there non-Hispanic counterparts in border states [OR 1.3 (1.1-1.6) p=0.009], which was not apparent in the non-border states [OR 1.0 (0.8-1.2) p=0.9].

CONCLUSIONS: There was an underutilization of thrombolytics and higher mortality in the Hispanic population admitted in border states but not in nonborder states. Further studies are warranted to better understand the associated factors.