A study conducted by neurology researchers at University of Texas Southwestern (UTSW) Medical Center has found lower-quality functional outcomes for Hispanic ischaemic stroke patients who receive endovascular thrombectomies than for comparable white patients. Outcomes were similar between white and Black ischaemic stroke patients receiving endovascular thrombectomies, the researchers also determined.
“This new study identifies populations that we should focus on in future research to gain a better understanding of the root causes of these disparities,” said the study’s lead author Erica Jones, assistant professor of neurology at UTSW Medical Center in Dallas, USA. “With understanding, targeted interventions can be developed to improve access to the best outcomes for all stroke patients.”
These findings, which are published in the Journal of Stroke and Cerebrovascular Diseases, add to the growing body of knowledge on improving stroke treatment in underserved groups—the researchers note—as previous studies have identified racial disparities in stroke outcomes and access to treatment.
In the study, a retrospective review of patients from a prospectively collected stroke registry in Houston, USA was conducted from August 2015 to June 2019. Patients aged 18 and older who received mechanical thrombectomy, and had race/ethnicity data belonging to the three largest racial/ethnic groups (non-Hispanic white, non-Hispanic Black and Hispanic), were included.
The study’s primary outcome was to evaluate differences in good functional outcome, defined as a 90-day modified Rankin Scale score (mRS) of 0–2, and secondary outcomes were discharge disposition, length of stay and excellent functional outcomes (90-day mRS score of 0–1).
Among a total of 666 patients who met the inclusion criteria, 45% were non-Hispanic white, 30% were non-Hispanic Black and 19% were Hispanic. The researchers also detail in their report that there were no significant racial differences in pre-morbid mRS scores, arrival National Institutes of Health Stroke Scale (NIHSS) scores, or tissue plasminogen activator (tPA) treatment rates.
They found there was no difference in primary outcomes by race when comparing non-Hispanic white patients to the other racial groups (odds ratio [OR]=1.08 [0.68–1.72]) but that, compared to Hispanic patients, non-Hispanic white patients had a higher likelihood of achieving an excellent functional outcome (OR=2.23 [1.01–4.93])—one of the study’s secondary outcomes.
The researchers conclude that, as such, “further study on disparities in post-acute stroke care is needed”. This research also builds on a study published by Jones et al in the Journal of Stroke and Cerebrovascular Diseases in 2020, which found that—among stroke patients under the age of 50—there was a higher prevalence of modifiable risk factors (including diabetes, hypertension and heart failure) in Black and Hispanic patients, as well as a decreased likelihood of good, early functional outcomes after ischaemic stroke.
