OCT 20, 2016

Race and Gender in Stroke Treatment

WRITTEN BY: Brenda Kelley Kim
When it comes to stroke, time is brain; this is a well-known medical fact. Getting the correct treatment immediately is crucial. So why would gender or race enter into the equation? With more people knowing the signs of stroke (FAST—Face, Arms, Speech and Time) and more medical facilities being equipped to treat stroke patients, it would seem that gender or race would have no impact on outcomes. As it happens, there is an impact, at least if the latest research is correct. A new study published online in the journal Neurology, a publication of the American Academy of Neurology, suggests that women and minorities may be slipping through the cracks in stroke treatment.
While there are different kinds of strokes, the most common by far, at 9 out of 10, are ischemic strokes, where a blood clot is blocking blood flow to the brain. In this kind of stroke the gold standard for treatment is the administration of tissue plasminogen activator (tPA). tPA drug therapy can break up a clot fairly quickly, removing the obstruction to blood flow. However, if patients are not given the drug, it cannot work and the latest research shows that women and minorities are at a disadvantage in this situation, at least statistically.

Study author Steven R. Messé, MD, of the University of Pennsylvania in Philadelphia and a Fellow of the American Academy of Neurology said, “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. 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.”

The study was a meta-analysis, where the team combined through thousands of pages of data. The hospital records of patients who arrived at the emergency department within two hours of the onset of stroke symptoms and were eligible for the drug, with no contraindications, were analyzed during an 8 year period from 2003 to 2011. In total, the team looked at 61,698 ischemic stroke patients.
After taking into account confounding factors including stroke severity, the researchers found that women and minorities were less likely to receive treatment. Of the records examined, 50.6% were from women, but female patients had an 8% higher chance of not receiving life-saving tPA treatment compared to men. African American patients were especially at risk, having 26% higher chance of missing out on tPA therapy compared to white patients. These two groups of patients combined made up over half of the patients included in the study and yet they were at a significantly higher risk of being under-treated.

It did matter where treatment was received. Patients treated at hospitals that were certified as stroke centers were much more likely to receive the gold standard of tPA treatment. Patients who were treated at hospitals that were not certified as stroke centers were half as likely to receive the clot busting drugs. The study was supported in part by Pfizer, Inc., and the Merck-Schering Plough Partnership. The video below talks about the symptoms of stroke and the impact they can have on the body, make sure you know the signs.

Sources: American Academy of Neurology , National Stroke Association, Perelman School of Medicine UPenn, Journal Neurology