Background: Intravenous thrombolysis (IVT) is the cornerstone of acute stroke therapy; however, is underutilized in minorities and women. In order to disentangle individual and system-based factors determining disparities in IVT use, we investigated race/sex differences in IVT utilization among hospitals serving varying proportions of minority patients.
Methods: Inpatient admissions for ischemic stroke patients were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of minority patients admitted with stroke (<25% minority patients [“white hospitals”], 25-50% minority patients [“mixed hospitals”], or >50% minority patients [“minority hospitals”]). Logistic regression was used to evaluate the association between race/sex and IVT use within and between the different hospital strata.
Results: A total of 337,201 stroke admissions were examined. Compared to white women, minority men, and minority women, the odds of IVT were highest for white men in any hospital strata; the odds of IVT for white men did not differ by hospital strata. For white women and minority men the odds of IVT were significantly lower in minority hospitals compared to white hospitals (OR 0.83, 95% CI 0.71-0.97, for white women; and OR 0.82, 95% CI 0.69-0.99, for minority men). The odds of IVT for minority women did not significantly differ by hospital strata. Race disparities in IVT use among women were observed in white hospitals (OR 0.88, 95% CI 0.78-0.99, in minority compared to white women), but not in minority hospitals (OR 0.94, 95% CI 0.82-1.09). Sex disparities in IVT use were observed among whites, but not minorities.
Conclusion: Minority men and white women have significantly lower odds of IVT in minority hospitals compared to white hospitals. IVT use in white men does not differ by hospital strata.