Racial disparities in refusal of stroke thrombolysis in Chicago

Scott J. Mendelson, Neelum T. Aggarwal, Christopher Thomas Richards, Kathleen O'Neill, Jane Louise Holl, Shyam Prabhakaran

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective To evaluate race differences in tissue plasminogen activator (tPA) refusal among eligible patients with acute ischemic stroke (AIS) in Chicago. Methods Using the Get With The Guidelines-Stroke registry data from 15 primary stroke centers between January 2013 and June 2015, we performed a retrospective analysis of patients with AIS presenting to the emergency department within 4.5 hours from symptom onset. Patient or proxy refusal was captured as a reason for nonadministration of tPA to eligible patients in the registry. We assessed whether tPA refusal differed by race using logistic regression. Results Among 704 tPA-eligible patients with AIS, tPA was administered to 86.2% (black race, 82.5% vs nonblack race, 89.5%; p < 0.001). Fifty-three (7.5%) tPA refusals were documented. Refusal was more common in black vs nonblack patients (10.6% vs 4.8%; p = 0.004). In multivariable analysis, the following were associated with tPA refusal: black race (adjusted odds ratio [OR] 2.5, 95% confidence interval [CI] 1.3-4.6), self-pay status (adjusted OR 3.23, 95% CI 1.2-8.71), prior stroke (adjusted OR 2.11, 95% CI 1.14-3.90), age (adjusted OR 1.04, 95% CI 1.02-1.07), and NIH Stroke Scale score (adjusted OR 0.94, 95% CI 0.90-0.99). Conclusions Among tPA-eligible patients with AIS in Chicago, over 7% refused tPA. Refusal was more common in black patients and accounted for the apparent lower rates of tPA use in black vs nonblack patients. Further research is needed to understand barriers to consent and overcome race-ethnic disparities in tPA treatment for AIS.

Original languageEnglish (US)
Pages (from-to)e359-e364
JournalNeurology
Volume90
Issue number5
DOIs
StatePublished - Jan 30 2018

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Tissue Plasminogen Activator
Stroke
Odds Ratio
Confidence Intervals
Registries
Proxy
Hospital Emergency Service
Logistic Models
Guidelines

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Mendelson, Scott J. ; Aggarwal, Neelum T. ; Richards, Christopher Thomas ; O'Neill, Kathleen ; Holl, Jane Louise ; Prabhakaran, Shyam. / Racial disparities in refusal of stroke thrombolysis in Chicago. In: Neurology. 2018 ; Vol. 90, No. 5. pp. e359-e364.
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title = "Racial disparities in refusal of stroke thrombolysis in Chicago",
abstract = "Objective To evaluate race differences in tissue plasminogen activator (tPA) refusal among eligible patients with acute ischemic stroke (AIS) in Chicago. Methods Using the Get With The Guidelines-Stroke registry data from 15 primary stroke centers between January 2013 and June 2015, we performed a retrospective analysis of patients with AIS presenting to the emergency department within 4.5 hours from symptom onset. Patient or proxy refusal was captured as a reason for nonadministration of tPA to eligible patients in the registry. We assessed whether tPA refusal differed by race using logistic regression. Results Among 704 tPA-eligible patients with AIS, tPA was administered to 86.2{\%} (black race, 82.5{\%} vs nonblack race, 89.5{\%}; p < 0.001). Fifty-three (7.5{\%}) tPA refusals were documented. Refusal was more common in black vs nonblack patients (10.6{\%} vs 4.8{\%}; p = 0.004). In multivariable analysis, the following were associated with tPA refusal: black race (adjusted odds ratio [OR] 2.5, 95{\%} confidence interval [CI] 1.3-4.6), self-pay status (adjusted OR 3.23, 95{\%} CI 1.2-8.71), prior stroke (adjusted OR 2.11, 95{\%} CI 1.14-3.90), age (adjusted OR 1.04, 95{\%} CI 1.02-1.07), and NIH Stroke Scale score (adjusted OR 0.94, 95{\%} CI 0.90-0.99). Conclusions Among tPA-eligible patients with AIS in Chicago, over 7{\%} refused tPA. Refusal was more common in black patients and accounted for the apparent lower rates of tPA use in black vs nonblack patients. Further research is needed to understand barriers to consent and overcome race-ethnic disparities in tPA treatment for AIS.",
author = "Mendelson, {Scott J.} and Aggarwal, {Neelum T.} and Richards, {Christopher Thomas} and Kathleen O'Neill and Holl, {Jane Louise} and Shyam Prabhakaran",
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Mendelson, SJ, Aggarwal, NT, Richards, CT, O'Neill, K, Holl, JL & Prabhakaran, S 2018, 'Racial disparities in refusal of stroke thrombolysis in Chicago' Neurology, vol. 90, no. 5, pp. e359-e364. https://doi.org/10.1212/WNL.0000000000004905

Racial disparities in refusal of stroke thrombolysis in Chicago. / Mendelson, Scott J.; Aggarwal, Neelum T.; Richards, Christopher Thomas; O'Neill, Kathleen; Holl, Jane Louise; Prabhakaran, Shyam.

In: Neurology, Vol. 90, No. 5, 30.01.2018, p. e359-e364.

Research output: Contribution to journalArticle

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T1 - Racial disparities in refusal of stroke thrombolysis in Chicago

AU - Mendelson, Scott J.

AU - Aggarwal, Neelum T.

AU - Richards, Christopher Thomas

AU - O'Neill, Kathleen

AU - Holl, Jane Louise

AU - Prabhakaran, Shyam

PY - 2018/1/30

Y1 - 2018/1/30

N2 - Objective To evaluate race differences in tissue plasminogen activator (tPA) refusal among eligible patients with acute ischemic stroke (AIS) in Chicago. Methods Using the Get With The Guidelines-Stroke registry data from 15 primary stroke centers between January 2013 and June 2015, we performed a retrospective analysis of patients with AIS presenting to the emergency department within 4.5 hours from symptom onset. Patient or proxy refusal was captured as a reason for nonadministration of tPA to eligible patients in the registry. We assessed whether tPA refusal differed by race using logistic regression. Results Among 704 tPA-eligible patients with AIS, tPA was administered to 86.2% (black race, 82.5% vs nonblack race, 89.5%; p < 0.001). Fifty-three (7.5%) tPA refusals were documented. Refusal was more common in black vs nonblack patients (10.6% vs 4.8%; p = 0.004). In multivariable analysis, the following were associated with tPA refusal: black race (adjusted odds ratio [OR] 2.5, 95% confidence interval [CI] 1.3-4.6), self-pay status (adjusted OR 3.23, 95% CI 1.2-8.71), prior stroke (adjusted OR 2.11, 95% CI 1.14-3.90), age (adjusted OR 1.04, 95% CI 1.02-1.07), and NIH Stroke Scale score (adjusted OR 0.94, 95% CI 0.90-0.99). Conclusions Among tPA-eligible patients with AIS in Chicago, over 7% refused tPA. Refusal was more common in black patients and accounted for the apparent lower rates of tPA use in black vs nonblack patients. Further research is needed to understand barriers to consent and overcome race-ethnic disparities in tPA treatment for AIS.

AB - Objective To evaluate race differences in tissue plasminogen activator (tPA) refusal among eligible patients with acute ischemic stroke (AIS) in Chicago. Methods Using the Get With The Guidelines-Stroke registry data from 15 primary stroke centers between January 2013 and June 2015, we performed a retrospective analysis of patients with AIS presenting to the emergency department within 4.5 hours from symptom onset. Patient or proxy refusal was captured as a reason for nonadministration of tPA to eligible patients in the registry. We assessed whether tPA refusal differed by race using logistic regression. Results Among 704 tPA-eligible patients with AIS, tPA was administered to 86.2% (black race, 82.5% vs nonblack race, 89.5%; p < 0.001). Fifty-three (7.5%) tPA refusals were documented. Refusal was more common in black vs nonblack patients (10.6% vs 4.8%; p = 0.004). In multivariable analysis, the following were associated with tPA refusal: black race (adjusted odds ratio [OR] 2.5, 95% confidence interval [CI] 1.3-4.6), self-pay status (adjusted OR 3.23, 95% CI 1.2-8.71), prior stroke (adjusted OR 2.11, 95% CI 1.14-3.90), age (adjusted OR 1.04, 95% CI 1.02-1.07), and NIH Stroke Scale score (adjusted OR 0.94, 95% CI 0.90-0.99). Conclusions Among tPA-eligible patients with AIS in Chicago, over 7% refused tPA. Refusal was more common in black patients and accounted for the apparent lower rates of tPA use in black vs nonblack patients. Further research is needed to understand barriers to consent and overcome race-ethnic disparities in tPA treatment for AIS.

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