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Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample
BACKGROUND AND PURPOSE: Sex and race disparities in recombinant tissue plasminogen activator (rt-PA) use have been reported. We sought to explore sex and race differences in the utilization of rt-PA at primary stroke centers (PSCs) compared to non-PSCs across the US. METHODS: Data from the National...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623663/ https://www.ncbi.nlm.nih.gov/pubmed/29021776 http://dx.doi.org/10.3389/fneur.2017.00500 |
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author | Boehme, Amelia K. Carr, Brendan G. Kasner, Scott Eric Albright, Karen C. Kallan, Michael J. Elkind, Mitchell S. V. Branas, Charles C. Mullen, Michael T. |
author_facet | Boehme, Amelia K. Carr, Brendan G. Kasner, Scott Eric Albright, Karen C. Kallan, Michael J. Elkind, Mitchell S. V. Branas, Charles C. Mullen, Michael T. |
author_sort | Boehme, Amelia K. |
collection | PubMed |
description | BACKGROUND AND PURPOSE: Sex and race disparities in recombinant tissue plasminogen activator (rt-PA) use have been reported. We sought to explore sex and race differences in the utilization of rt-PA at primary stroke centers (PSCs) compared to non-PSCs across the US. METHODS: Data from the National (Nationwide) Inpatient Sample (NIS) 2004–2010 was utilized to assess sex differences in treatment for ischemic stroke in PSCs compared to non-PSCs. RESULTS: There were 304,152 hospitalizations with a primary diagnosis of ischemic stroke between 2004 and 2010 in the analysis: 75,160 (24.7%) patients were evaluated at a PSC. A little over half of the patients evaluated at PSCs were female (53.8%). A lower proportion of women than men received rt-PA at both PSCs (6.8 vs. 7.5%, p < 0.001) and non-PSCs (2.3 vs. 2.8%, p < 0.001). After adjustment for potential confounders the odds of being treated with rt-PA remained lower for women regardless of presentation to a PSC (OR 0.87, 95% CI 0.81–0.94) or non-PSC (OR 0.88, 95% CI 0.82–0.94). After stratifying by sex and race, the lowest absolute treatment rates were observed in black women (4.4% at PSC, 1.9% at non-PSC). The odds of treatment, relative to white men, was however lowest for white women (PSC OR = 0.85, 95% CI 0.78–0.93; non-PSC OR = 0.80, 95% CI 0.75–0.85). In the multivariable model, sex did not modify the effect of PSC certification on rt-PA utilization (p-value for interaction = 0.58). CONCLUSION: Women are less likely to receive rt-PA than men at both PSCs and non-PSCs. Absolute treatment rates are lowest in black women, although the relative difference in men and women was greatest for white women. |
format | Online Article Text |
id | pubmed-5623663 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-56236632017-10-11 Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample Boehme, Amelia K. Carr, Brendan G. Kasner, Scott Eric Albright, Karen C. Kallan, Michael J. Elkind, Mitchell S. V. Branas, Charles C. Mullen, Michael T. Front Neurol Neuroscience BACKGROUND AND PURPOSE: Sex and race disparities in recombinant tissue plasminogen activator (rt-PA) use have been reported. We sought to explore sex and race differences in the utilization of rt-PA at primary stroke centers (PSCs) compared to non-PSCs across the US. METHODS: Data from the National (Nationwide) Inpatient Sample (NIS) 2004–2010 was utilized to assess sex differences in treatment for ischemic stroke in PSCs compared to non-PSCs. RESULTS: There were 304,152 hospitalizations with a primary diagnosis of ischemic stroke between 2004 and 2010 in the analysis: 75,160 (24.7%) patients were evaluated at a PSC. A little over half of the patients evaluated at PSCs were female (53.8%). A lower proportion of women than men received rt-PA at both PSCs (6.8 vs. 7.5%, p < 0.001) and non-PSCs (2.3 vs. 2.8%, p < 0.001). After adjustment for potential confounders the odds of being treated with rt-PA remained lower for women regardless of presentation to a PSC (OR 0.87, 95% CI 0.81–0.94) or non-PSC (OR 0.88, 95% CI 0.82–0.94). After stratifying by sex and race, the lowest absolute treatment rates were observed in black women (4.4% at PSC, 1.9% at non-PSC). The odds of treatment, relative to white men, was however lowest for white women (PSC OR = 0.85, 95% CI 0.78–0.93; non-PSC OR = 0.80, 95% CI 0.75–0.85). In the multivariable model, sex did not modify the effect of PSC certification on rt-PA utilization (p-value for interaction = 0.58). CONCLUSION: Women are less likely to receive rt-PA than men at both PSCs and non-PSCs. Absolute treatment rates are lowest in black women, although the relative difference in men and women was greatest for white women. Frontiers Media S.A. 2017-09-27 /pmc/articles/PMC5623663/ /pubmed/29021776 http://dx.doi.org/10.3389/fneur.2017.00500 Text en Copyright © 2017 Boehme, Carr, Kasner, Albright, Kallan, Elkind, Branas and Mullen. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neuroscience Boehme, Amelia K. Carr, Brendan G. Kasner, Scott Eric Albright, Karen C. Kallan, Michael J. Elkind, Mitchell S. V. Branas, Charles C. Mullen, Michael T. Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample |
title | Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample |
title_full | Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample |
title_fullStr | Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample |
title_full_unstemmed | Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample |
title_short | Sex Differences in rt-PA Utilization at Hospitals Treating Stroke: The National Inpatient Sample |
title_sort | sex differences in rt-pa utilization at hospitals treating stroke: the national inpatient sample |
topic | Neuroscience |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623663/ https://www.ncbi.nlm.nih.gov/pubmed/29021776 http://dx.doi.org/10.3389/fneur.2017.00500 |
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