After an ischemic stroke, patients in minority groups are more likely to get short- and long-term life-sustaining procedures instead of removal of the culprit blockage, a large study suggests.
The research, published in JAMA Neurology, showed that even after multivariable adjustment, non-white patients were more likely to get life-sustaining procedures, namely:
- Gastrostomy (38.4% versus 29.5% for white peers, odds ratio [OR] 1.56, 95% CI 1.48-1.65);
- Tracheostomy (48.0% versus 29.8%, OR 1.44, 95% CI 1.30-1.61);
- Mechanical ventilation (36.5% versus 29.6%, OR 1.16, 95% CI 1.09-1.24); and
- Hemicraniectomy (46.9% versus 29.8%, OR 1.36, 95% CI 1.11-1.66).
In contrast, the minority subgroup underwent less intravenous thrombolysis (OR 0.80, 95% CI 0.75-0.86) and carotid revascularization (OR 0.57, 95% CI 0.50-0.66) —procedures that go to the root of the problem — according to Roland Faigle, MD, PhD, of Johns Hopkins University School of Medicine, and coauthors.
These data suggest an “underutilization of procedures with curative intent” for minorities, they concluded.
“Contrasting differences among procedure groups may allow for a bird’s-eye view of stroke-related procedure utilization. A better understanding of commonalities within and differences between curative and life-sustaining procedures may facilitate the development of effective strategies aimed at eliminating racial disparities in the delivery of stroke care.”
Faigle’s group used data from the Nationwide Inpatients Sample for 340,463 patients.
“We acknowledge that certain clinical characteristics not captured in the Nationwide Inpatient Sample, such as stroke severity, stroke location, and time to presentation, may partially explain our results,” the authors wrote.
Faigle disclosed no relevant conflicts of interest.
Faigle R, et al “Racial differences in utilization of life-sustaining vs curative inpatient procedures after stroke” JAMA Neurol 2016; DOI: 10.1001/jamaneurol.2016.1914.