Department of Neurology, University of Texas Southwestern, 5323 Harry Hines Blvd, Dallas, TX 75390, United States.
Department of Neurology, University of Texas McGovern Medical School, Houston, TX 77030, United States.
J Stroke Cerebrovasc Dis. 2021 Dec;30(12):106131. doi: 10.1016/j.jstrokecerebrovasdis.2021.106131. Epub 2021 Oct 14.
Previous studies have shown racial disparities in access to treatment and outcomes in ischemic stroke patients. We sought to define racial disparities in functional outcomes among ischemic stroke patients receiving endovascular thrombectomy (EVT).
We performed a retrospective review of patients in our institution's prospectively collected stroke patient registry from 08/2015 to 06/2019 at 1 comprehensive and 2 thrombectomy-ready stroke centers. We reviewed patients aged ≥ 18 who received mechanical thrombectomy including only patients with race/ethnicity data belonging to the 3 largest race/ethnic groups: Non-Hispanic White (NHW), Non-Hispanic Black (NHB), and Hispanic (HIS). We compared baseline characteristics and performed multivariable logistic regression to evaluate differences in good functional outcome defined as 90-day modified Rankin score (90 day mRS 0-2) as the primary outcome. Secondary outcomes were discharge disposition, length of stay, and excellent functional outcome (90 day mRS 0-1). Results are given as OR [95% CI].
Among 666 patients that met inclusion criteria, 45% were NHW, 30% were NHB, and 19% were HIS. NHB and HIS patients were younger than NHW (average age NHB 62; HIS 64; and NHW 70; p < 0.001). Diabetes was more prevalent in NHB (32%, p = 0.02) and HIS (47%, p < 0.001) compared to NHW (23%). There were no significant racial differences in pre-morbid mRS, arrival NIHSS, tPA treatment rates. There was no difference in primary outcome by race comparing NHW to the other racial groups (OR 1.08 [0.68-1.72]) but compared to HIS patients, NHW had a higher likelihood of the secondary outcome of excellent functional outcome (aOR 2.23 [1.01-4.93]) defined as mRS 0-1.
In this study of over 600 patients treated with EVT, we did not find significant racial disparities in functional outcome except for less excellent functional outcome in HIS compared to NHW. Further study on disparities in post-acute stroke care is needed.
先前的研究表明，在缺血性脑卒中患者的治疗和预后方面存在种族差异。我们旨在确定接受血管内血栓切除术（EVT）治疗的缺血性脑卒中患者的功能结局的种族差异。
我们对 2015 年 8 月至 2019 年 6 月期间在我们机构前瞻性收集的卒中患者登记处的患者进行了回顾性研究，这些患者来自于 1 个综合性和 2 个血栓切除术准备就绪的卒中中心。我们回顾了年龄≥18 岁并接受机械血栓切除术的患者，包括仅属于 3 个最大种族/族裔群体的患者：非西班牙裔白人（NHW）、非西班牙裔黑人（NHB）和西班牙裔（HIS）。我们比较了基线特征，并进行了多变量逻辑回归分析，以评估主要结局（90 天改良 Rankin 评分（90 天 mRS）0-2）定义的良好功能结局的差异。次要结局是出院处置、住院时间和优秀的功能结局（90 天 mRS 0-1）。结果以比值比（OR）[95%置信区间]表示。
在符合纳入标准的 666 名患者中，45%为 NHW，30%为 NHB，19%为 HIS。NHB 和 HIS 患者比 NHW 年轻（平均年龄 NHB 为 62；HIS 为 64；NHW 为 70；p<0.001）。与 NHW（23%）相比，NHB（32%，p=0.02）和 HIS（47%，p<0.001）中糖尿病更为常见。种族间在发病前 mRS、到达 NIHSS、tPA 治疗率方面无显著差异。与 NHW 相比，NHW 与其他种族组之间在主要结局上没有差异（OR 1.08 [0.68-1.72]），但与 HIS 患者相比，NHW 具有更高的次要结局（mRS 0-1）优秀功能结局的可能性（aOR 2.23 [1.01-4.93]）。
在这项对 600 多名接受 EVT 治疗的患者进行的研究中，我们没有发现功能结局方面存在显著的种族差异，但与 NHW 相比，HIS 的优秀功能结局较少。需要进一步研究急性后卒中护理方面的差异。
