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 Nonwhite patients were significantly less likely to get clot-busting
therapy, for example, or to undergo a procedure to reopen a clogged
artery in the neck that carries blood to the brain.
“Desirable” curative and preventive measures, “with excellent
evidence for good outcome,” were underutilized in minority patients,
said lead author Dr. Roland Faigle of Johns Hopkins University
School of Medicine in Baltimore.
And “procedures meant for ‘damage control’ and based on (in some
instances) shaky evidence” were overused in minorities, Faigle told
Reuters Health by email.
To assess the extent of racial disparities in care, Faigle and
colleagues looked at data from a nationwide sample of hospitalized
stroke patients from 2007 to 2011.
They took into account a variety of factors that can influence
stroke care in the hospital, including patient age, gender,
insurance status, and other medical conditions that might make
treatment more complicated, like diabetes or high blood pressure.
They also adjusted for hospital characteristics like the annual
volume of stroke cases, total number of beds and whether it was a
teaching hospital.
They found that nonwhite patients were 20 percent less likely to get
a clot-busting therapy known as intravenous thrombolysis. They also
had 43 percent lower odds of getting a procedure to reopen the
carotid artery to prevent further stroke.
The researchers also looked at four procedures that Faigle says
aren’t backed by evidence of effectiveness in stroke patients:
feeding tubes in the stomach, incisions in the wind pipe to aid
breathing, mechanical ventilation for breathing assistance, and
surgery to relieve swelling in the brain.
Minorities were 56 percent more likely to have feeding tubes than
white patients, researchers report in JAMA Neurology.
Nonwhite patients were also 44 percent more likely to get incisions
in the wind pipe to aide breathing and 36 percent more likely to
receive surgery to relieve swelling in the brain.
One limitation of the study is that researchers lacked data on some
patient characteristics that could influence what care they received
such as stroke severity, stroke location and how much time passed
between when symptoms started and patients arrived at the hospital,
the authors note.
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“We know there are significant differences in these clinical aspects
with minorities typically having the more severe strokes with delays
in time to care,” said Dr. Daniel Lackland, a neurology researcher
at the Medical University of South Carolina in Charleston.
But the findings still point to a need for improvement.
“These results do suggest that all stroke cases do not have the same
stroke care, and should stimulate implementation studies to increase
access and utilization,” Lackland, who wasn’t involved in the study,
said by email.
The findings also add to growing evidence pointing to racial
disparities in care for a wide range of emergencies, including heart
attacks, heart failure and stroke, said Dr. Emily Bucholz, a
researcher at Boston Children's Hospital who wasn’t involved in the
study.
“Although the reasons for these disparities are unclear, they may be
related to racial disparities in access to care, differences in
clinical presentation or procedural indications between minorities
and whites, physician biases, or patient preferences,” Bucholz said
by email.
SOURCE: http://bit.ly/LSa1MM JAMA Neurology, online July 25, 2016.
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