title: Individual and System Contributions to Race and Sex Disparities in Thrombolysis Use for Stroke Patients in the United States.
abstract: Intravenous thrombolysis (IVT) is underutilized in ethnic minorities and women. To disentangle individual and system-based factors determining disparities in IVT use, we investigated race/sex differences in IVT utilization among hospitals serving varying proportions of minority patients.
  
  
  
  Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of minority patients admitted with stroke (<25% minority patients [white hospitals], 25% to 50% minority patients [mixed hospitals], or >50% minority patients [minority hospitals]). Logistic regression was used to evaluate the association between race/sex and IVT use within and between the different hospital strata.
  
  
  
  Among 337 201 stroke admissions, white men had the highest odds of IVT among all race/sex groups in any hospital strata, and the odds of IVT for white men did not differ by hospital strata. For white women and minority men, the odds of IVT were significantly lower in minority hospitals compared with white hospitals (odds ratio, 0.83; 95% confidence interval, 0.71-0.97, for white women; and odds ratio, 0.82; 95% confidence interval, 0.69-0.99, for minority men). Race disparities in IVT use among women were observed in white hospitals (odds ratio, 0.88; 95% confidence interval, 0.78-0.99, in minority compared with white women), but not in minority hospitals (odds ratio, 0.94, 95% confidence interval, 0.82-1.09). Sex disparities in IVT use were observed among whites but not among minorities.
  
  
  
  Minority men and white women have significantly lower odds of IVT in minority hospitals compared with white hospitals. IVT use in white men does not differ by hospital strata.
authors.affiliation: From the Department of Neurology (R.F., V.C.U., R.F.G.) and Department of Medicine (L.A.C.), Johns Hopkins University School of Medicine, Baltimore, MD. rfaigle1@jhmi.edu.
authors.forename: Roland
authors.initials: R
authors.lastname: Faigle
authors.affiliation: From the Department of Neurology (R.F., V.C.U., R.F.G.) and Department of Medicine (L.A.C.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Victor C
authors.initials: VC
authors.lastname: Urrutia
authors.affiliation: From the Department of Neurology (R.F., V.C.U., R.F.G.) and Department of Medicine (L.A.C.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
authors.affiliation: From the Department of Neurology (R.F., V.C.U., R.F.G.) and Department of Medicine (L.A.C.), Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Gottesman
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D014481:United States; D044465:White People / Q000706:statistics & numerical data*
keywords: female; healthcare disparities; hospitalization; minority health; stroke; thrombolytic therapy