The association of race and sex with the underuse of stroke prevention measures.
BACKGROUND
Underuse of effective stroke prevention measures has been demonstrated in the general population. Blacks and Hispanics are at increased risk of recurrent stroke relative to white non-Hispanics. More profound underuse of prevention measures may contribute to this disparity. In this study we attempted to compare the degree of underuse of diagnostic and treatment strategies in patients of these racial/ethnic groups with recent ischemic stroke.


METHODS
At 4 participating urban hospitals, patient charts were reviewed with regard to the completeness of the diagnostic evaluation, discharge treatment regimen, and stroke risk factor and antithrombotic medication use at 6 months postdischarge.


RESULTS
Of 501 patients hospitalized with acute ischemic stroke, almost all received electrocardiograms and brain imaging, 75% had carotid artery evaluations, and 70% had serum lipid determinations. Blacks and women were less likely to have complete evaluations. At discharge, 88% of patients received antithrombotic medications and 89% of patients were prescribed antihypertensive medications appropriately, but only 65% were prescribed lipid-lowering medications appropriately, with blacks least likely to receive appropriate prescriptions. At 6 months poststroke, of the 200 patients with data available for evaluation, 72% exhibited underuse of at least one stroke prevention measure. Blacks (81.6%) were more likely to experience underuse than Hispanics (62.5%) or whites (66.7%). Women were more likely to receive incomplete inhospital evaluations and discharge regimens.


CONCLUSIONS
There is clinically important underuse of effective diagnostic and prevention measures in each of the groups studied, especially among blacks.
Tuhrim
Stanley
S
Department of Neurology, Mount Sinai School of Medicine, New York, New York 10029, USA. stanley.tuhrim@msnyuhealth.org
Cooperman
Alice
A
Rojas
Mary
M
Brust
John C M
JC
Koppel
Barbara
B
Martin
Kevin
K
Chassin
Mark
M
D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015897:Comorbidity; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008571:Men / Q000523:psychology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D044465:White People / Q000523:psychology; D014930:Women / Q000523:psychology*
D000959:Antihypertensive Agents; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents