For ischaemic stroke patients, social factors like education, neighbourhood and employment may be linked to whether they receive treatment with intravenous, clot-busting drugs, according to a preliminary study that was released recently and is set to be presented at the American Academy of Neurology’s (AAN) 76th annual meeting (13–18 April 2024, Denver, USA).
“Any barriers that prevent people with stroke from receiving clot-busting drugs, known as thrombolytic therapy, can result in devastating consequences,” said study author Chanaka Nadeeshan Kahathuduwa (Texas Tech University Health Sciences Center, Lubbock, USA). “Our study found that a number of factors like race, insurance status, where a person lives, and other social determinants of health, impacted whether a person received this crucial treatment.”
The study involved 63,983 people with ischaemic stroke identified through public health records in Texas. Regarding race and ethnicity, 67% of participating patients were white, 18% were Black, and 27% were Hispanic, with some participants having more than one race and ethnicity. Researchers also determined that 7,198 patients (11%) received clot-busting drugs.
They then looked at social factors that may impact a person’s health, such as income, education, housing, and access to health services. To rank patients based on these factors, they used US Census data and applied a measure called the Social Vulnerability Index (SVI), before dividing the patients into four groups.
Among the 7,930 people in the group identified as having the least disadvantage, 1,037 received clot-busting drugs. Among the 7,966 people in the group identified as having the most disadvantage, 964 received these drugs. After adjusting for age, sex, and education, the researchers found that those with the least disadvantage were 13% more likely to receive clot-busting drugs than those in the other groups.
When looking specifically at race and ethnicity, they also identified that Black people were 10% less likely to receive thrombolytic therapy compared to white people. In addition, Hispanic people were 7% less likely to receive this therapy than non-Hispanic people.
Regarding insurance coverage, the researchers found that those who were on Medicare, Medicaid or Veterans Assistance were 23% less likely to be treated using clot-busting drugs compared to those with private insurance, while uninsured patients were 10% less likely to receive the therapy compared to those privately insured.
Lastly, after looking at location, the researchers found that participants who lived in rural areas were 40% less likely to receive the treatment than those living in urban areas.
“Our results are concerning and shed light on healthcare disparities,” said Kahathuduwa. “This study demonstrates how social disadvantages may translate to worse stroke care. Further studies are needed to investigate this connection between society, the healthcare system, and stroke outcomes. Finding new approaches to address these social factors is imperative for improving equity in stroke care and recovery.”
Kahathuduwa noted that clot-busting drugs must be administered within a few hours after the onset of stroke symptoms. As such, a limitation of the present study is that it was not known how many of the participants were seen at the hospital within the relevant timeframe and, thus, would have been eligible to receive thrombolytic therapy.
