Are there Disparities in Thrombolytic Treatment and Mortality in Acute Ischemic Stroke in Hispanics Compared to non-Hispanics Living in Border States?

Background – Recent studies have found an underutilization of hospital in-patient care for coronary artery disease in Hispanics living in border states. The purpose of this study is to determine whether there is a similar disparity in the treatment of acute ischemic stroke in Hispanics living in border states. Methods  – We identified Hispanic and non-Hispanic acute ischemic stroke patients from the Nationwide Inpatient Sample-2011 data files. We determined the rate of utilization of thrombolytics and outcomes according to patient’s demographic and clinical characteristics and whether or not they lived in a border state (defined as California, Arizona, New Mexico and Texas). Results – A total of 34,904 Hispanic patients were admitted with ischemic stroke; of those, 21,130 were admitted in border states and 13,774 in non-border states. There was a significantly lower rate of thrombolytic use in Hispanic patients 1013 (4.8%) and non-Hispanics (5326 (5.7%, p=0.05)). After adjusting for age, gender, and other confounding risk factors, Hispanics were 30% more likely to suffer in-hospital mortality versus their non-Hispanic counterparts in border states [OR 1.3 (1.1-1.6) p=0.009], which was not apparent in the non-border states [OR 1.0 (0.8-1.2) p=0.9]. Conclusions  – There was an underutilization of thrombolytics and higher mortality in the Hispanic population admitted in border states but not in non-border states. Further studies are warranted to better understand the associated factors.