Racial disparities in receipt of secondary stroke prevention agents among US nursing home residents.
OBJECTIVE
Although medications can significantly reduce the risk of recurrent stroke, little is known about the extent to which such therapies are given to nursing home residents. We sought to evaluate the extent to which people of color were less likely to receive pharmacological agents in the treatment of recurrent stroke while living in US nursing homes.


METHODS
We identified 19 051 residents with a recent hospitalization and primary discharge diagnosis of 434 or 436 in 5 states from 1992 to 1996; of these, 7053 had concomitant conditions indicating anticoagulant therapy. We considered aspirin, dipyridamole, ticlopidine, or warfarin alone or in combination as secondary drug prevention. Generalized linear models provided estimates of the absolute difference in prevalence estimates of the receipt of agents used for the prevention of recurrent stroke between each race-ethnicity group adjusted for potential confounders.


RESULTS
Variability in use of any treatment was observed by race-ethnicity ranging from 58% of American Indians receiving therapy to only 39% of Asian/Pacific Islanders. Among residents with an indication for anticoagulant therapy, the absolute estimated crude differences indicated that residents of color were less likely than non-Hispanic whites to receive warfarin. After controlling for confounding, Asian/Pacific Islanders, blacks, and Hispanics eligible for anticoagulant therapy received warfarin less often than non-Hispanic white residents.


CONCLUSIONS
Overall, only half of our elderly population received any pharmacological agent for secondary prevention of stroke. Interventions designed to improve the pharmacological management of recurrent stroke regardless of race are needed in the nursing home setting.
Christian
Jennifer B
JB
Brown University Center for Gerontology and Health Care Research, Providence, RI, USA. Jennifer_Christian@brown.edu
Lapane
Kate L
KL
Toppa
Rebecca S
RS
D000368:Aged; D000925:Anticoagulants / Q000145:classification / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage; D016208:Databases, Factual / Q000706:statistics & numerical data; D004176:Dipyridamole / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D006297:Health Services Accessibility; D006801:Humans; D009735:Nursing Homes / Q000592:standards; D011287:Prejudice; D011315:Preventive Medicine / Q000706:statistics & numerical data; D044469:Racial Groups / Q000145:classification / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D055502:Secondary Prevention; D020521:Stroke / Q000208:ethnology* / Q000517:prevention & control; D013988:Ticlopidine / Q000008:administration & dosage; D014481:United States; D014859:Warfarin / Q000008:administration & dosage
D000925:Anticoagulants; D014859:Warfarin; D004176:Dipyridamole; D013988:Ticlopidine; D001241:Aspirin