title: Racial disparities in tissue plasminogen activator treatment rate for stroke: a population-based study.
abstract: OBJECTIVE
  Some prior studies have shown that racial disparities exist in intravenous tissue plasminogen activator (tPA) use for acute ischemic stroke. We sought to determine whether race was associated with tPA treatment for stroke in a predominantly black urban population.
  
  
  METHODS
  Systematic chart abstraction was performed on consecutive hospitalized patients with ischemic stroke from all 7 acute care hospitals in the District of Columbia from February 1, 2008, to January 31, 2009.
  
  
  RESULTS
  Of 1044 patients with ischemic stroke, 74% were black, 19% non-Hispanic white, and 5% received intravenous tPA. Blacks were one third less likely than whites to receive intravenous tPA (3% versus 10%, P<0.001). However, blacks were also less likely than whites to present within 3 hours of symptom onset (13% versus 21%, P=0.004) and also less likely to be tPA-eligible (5% versus 13%, P<0.001). Of those who presented within 3 hours, blacks were almost half as likely to be treated with intravenous tPA than whites (27% versus 46%, P=0.023). The treatment rate for tPA-eligible patients was similar for blacks and whites (70% versus 76%, P=0.62).
  
  
  CONCLUSIONS
  In this predominantly black urban population hospitalized for acute ischemic stroke, blacks were significantly less likely to be treated with intravenous 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.
authors: Washington Hospital Center, Washington, DC 20010, USA. hsiaa@ninds.nih.gov
authors: Amie W
authors: AW
authors: Hsia
authors: Dorothy F
authors: DF
authors: Edwards
authors: Lewis B
authors: LB
authors: Morgenstern
authors: Jeffrey J
authors: JJ
authors: Wing
authors: Nina C
authors: NC
authors: Brown
authors: Regina
authors: R
authors: Coles
authors: Sarah
authors: S
authors: Loftin
authors: Andrea
authors: A
authors: Wein
authors: Sara S
authors: SS
authors: Koslosky
authors: Sabiha
authors: S
authors: Fatima
authors: Brisa N
authors: BN
authors: Sánchez
authors: Ali
authors: A
authors: Fokar
authors: M Chris
authors: MC
authors: Gibbons
authors: Nawar
authors: N
authors: Shara
authors: Annapurni
authors: A
authors: Jayam-Trouth
authors: Chelsea S
authors: CS
authors: Kidwell
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D044465:White People
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator