Women, minorities may be undertreated for stroke

"Even though the clot-busting treatment for stroke called tPA improves recovery, some people who are eligible to receive the treatment are not getting it," said study author Steven R. Messé, MD, of the University of Pennsylvania in Philadelphia and a Fellow of the American Academy of Neurology. "We wanted to find out what factors were associated with lower likelihood of treatment, which may help us find ways to improve tPA use in the future."

For the study, the researchers looked back at more than eight years of hospital records from across the country of people with an ischemic stroke who arrived at the hospital within two hours after the start of stroke symptoms and had no documented reasons that they could not receive the treatment. The treatment, tissue plasminogen activator (tPA), can be used only for ischemic strokes, which are caused by blood clots. It cannot be used for hemorrhagic strokes, which are caused by bleeding.

Of the 61,698 people in the study, 15,282 people, or 25 percent, did not receive the treatment within three hours. Treatment rates improved over time, with 45 percent of those eligible receiving treatment from 2003-2005 compared to 82 percent from 2010-2011.

After accounting for other factors that could affect treatment, including stroke severity, the researchers found that women and minorities were less likely to receive treatment. Women had 8 percent higher odds of not receiving treatment than men. While women made up 50.6 percent of the total study group, they made up 50.1 percent of those receiving treatment. African-Americans had 26 percent higher odds of not receiving treatment than whites, while those of other races had 17 percent higher odds of not receiving treatment than whites.

Other factors associated with under treatment included older age and less severe strokes. "More research is needed about why these potential disparities exist and how they can be addressed," Messé said.

People who were treated at hospitals certified as stroke centers were more likely to receive treatment than those at hospitals without the certification, with those at primary stroke centers having nearly twice the odds of receiving tPA.