Faigle Roland, Urrutia Victor C, Cooper Lisa A, Gottesman Rebecca F
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.
Stroke. 2017 Apr;48(4):990-997. doi: 10.1161/STROKEAHA.116.015056. Epub 2017 Mar 10.
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.
静脉溶栓治疗（IVT）在少数族裔和女性中未得到充分利用。为了厘清决定IVT使用差异的个体因素和基于系统的因素，我们调查了服务不同比例少数族裔患者的医院中IVT使用情况的种族/性别差异。
从2007年至2011年的全国住院患者样本中确定缺血性卒中入院病例。医院根据卒中入院的少数族裔患者百分比进行分类（少数族裔患者<25%[白人医院]，少数族裔患者25%至50%[混合医院]，或少数族裔患者>50%[少数族裔医院]）。使用逻辑回归来评估不同医院分层内和分层间种族/性别与IVT使用之间的关联。
在337201例卒中入院病例中，在任何医院分层中，白人男性在所有种族/性别组中接受IVT的几率最高，且白人男性接受IVT的几率在不同医院分层之间没有差异。对于白人女性和少数族裔男性，与白人医院相比，少数族裔医院中接受IVT的几率显著更低（白人女性的比值比为0.83；95%置信区间为0.71 - 0.97；少数族裔男性的比值比为0.82；95%置信区间为0.69 - 0.99）。在白人医院中观察到女性IVT使用的种族差异（少数族裔女性与白人女性相比，比值比为0.88；95%置信区间为0.78 - 0.99），但在少数族裔医院中未观察到（比值比为0.94，95%置信区间为0.82 - 1.09）。在白人中观察到IVT使用的性别差异，但在少数族裔中未观察到。
与白人医院相比，少数族裔医院中少数族裔男性和白人女性接受IVT的几率显著更低。白人男性接受IVT的情况在不同医院分层之间没有差异。
