Background: Since the introduction of recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke, rt-PA rate and number of stroke centers have increased. Despite this, studies have shown racial and ethnic disparities in stroke care especially in Black and Hispanic populations. How Hispanic ethnicity affects rt-PA evaluations has to date been unclear. In our patient population, we investigated whether ethnicity is associated with rt-PA use for acute ischemic strokes in the Hispanic population.
Methods: We performed a retrospective review of IRB approved, prospectively collected data from the UC San Diego Stroke Registry. Patients were selected based on the presentation and primary diagnosis of Transient Ischemic Attack or Ischemic Stroke. Characteristics including risk factors were compared in Hispanic vs non-Hispanic samples to assess rt-PA treatment rates, process of care intervals for Hispanics vs non-Hispanics and rt-PA vs non-rt-PA patients.
Results: We assessed 1489 patients (300 Hispanic vs. 1189 non-Hispanic whites) from July 2004 to July 2016. Comparing Hispanics to non-Hispanics, there was no difference in rt-PA rate (35.3% vs. 33.1%; p=0.49). In a subset evaluation of Hispanics only, comparing rt-PA(-) to rt-PA(+), there was no difference for male sex (56%), Hypertension (71%), Hyperlipidemia (29%), Diabetes (43%), Atrial Fibrillation (23%), and Smoking (20%). There was a noted difference in the Hispanic-only untreated vs treated subset for initial NIHSS (7.24 vs. 13.27; p<.001). In rt-PA treated patients only, the “onset to treatment” interval was significantly higher in Hispanics (2.42 vs. 2.13 hours p=0.003), while the “door to treatment” interval was not different (1.13 vs. 1.02 hours; p=0.07).
Conclusions: This study shows the rate of rt-PA treatment and “door to treatment” intervals were not significantly different in Hispanic vs non-Hispanic patients. This data is supportive of current overall treatment decision models. However, the “onset to treatment” interval was significantly longer for Hispanic patients showing that it may take longer for this population to reach the treating hospital. This supports the need to develop culturally relevant education programs to address barriers in this population.