Introduction: Minorities with ischemic strokes are younger and less likely to receive intravenous tissue plasminogen activator (IV tPA) compared to whites; However, disparities in the use of IV tPA in the multi-ethnic population of Hawaii have not been adequately studied.
Hypothesis: Native Hawaiians and other Pacific Islanders (NHOPI) and Asians who are hospitalized with ischemic stroke receive less IV tPA compared to whites.
Methods: We conducted a retrospective study on consecutive young adult patients (age ≤55) hospitalized for ischemic stroke at a single tertiary center on Oahu between 2006 and 2012. Clinical characteristics and the use of IV tPA among NHOPI and Asians were compared to whites. Patients without race/ethnicity data (n=28) and postoperative strokes (n=22) were excluded.
Results: A total of 462 consecutive young adult (mean age 47±9 years) ischemic stroke patients (whites 16%, Asians 36%, NHOPI 43%, Other 5%) were studied. NHOPI had higher prevalence of hypertension (NHOPI 75% vs. whites 49%, p<0.0001), diabetes (NHOPI 46% vs. whites 22%, p=0.0003), higher body mass index (NHOPI 33±9 cm/m2 vs. whites 28±7 cm/m2, p<0.0001), and hemoglobin A1c (NHOPI 8.9 ± 2.9% vs. whites 7.2 ± 2.5%, p=0.002) compared to whites. Clinical characteristics were similar between Asians and whites. The use of IV tPA was lower among NHOPI (4.6%, p=0.01) and Asians (3.0%, p=0.002) compared to whites (13.2%).
Conclusions: NHOPI represented the major ethnic group among the young adult stroke population in Hawaii and had higher instances of hypertension and diabetes compared to whites. NHOPI and Asians both had significantly lower rates of IV tPA use compared to whites. Further study is needed to assess the barriers associated with the use of IV tPA among these minority groups.