Ten-Year Trend in Age, Sex, and Racial Disparity in tPA (Alteplase) and Thrombectomy Use Following Stroke in the United States.

Autor:	Otite FO; Departments of Neurology (F.O.O., K.A., E.S., J.G.L.), State University of New York (SUNY) Upstate Medical University, Syracuse., Saini V; University of Miami, FL (V.S., N.B.S., A.M.M., R.L.S.)., Sur NB; University of Miami, FL (V.S., N.B.S., A.M.M., R.L.S.)., Patel S; University of Connecticut, Hartford (S.P.)., Sharma R; Yale University, New Haven, CT (R.S.)., Akano EO; Molecular Neuropharmacology Unit, National Institute of Neurological Disorders and Stroke, Bethesda, MD (E.O.A.)., Anikpezie N; Department of Healthcare Transformation Initiative, University of Texas Health Science Center at Houston (N.A.)., Albright K; Departments of Neurology (F.O.O., K.A., E.S., J.G.L.), State University of New York (SUNY) Upstate Medical University, Syracuse., Schmidt E; Departments of Neurology (F.O.O., K.A., E.S., J.G.L.), State University of New York (SUNY) Upstate Medical University, Syracuse., Hoffman H; Department of Neurosurgery (H.H., G.G.), State University of New York (SUNY) Upstate Medical University, Syracuse., Gould G; Department of Neurosurgery (H.H., G.G.), State University of New York (SUNY) Upstate Medical University, Syracuse., Khandelwal P; State University of New Jersey, Newark (P.K.)., Latorre JG; Departments of Neurology (F.O.O., K.A., E.S., J.G.L.), State University of New York (SUNY) Upstate Medical University, Syracuse., Malik AM; University of Miami, FL (V.S., N.B.S., A.M.M., R.L.S.)., Sacco RL; University of Miami, FL (V.S., N.B.S., A.M.M., R.L.S.)., Chaturvedi S; University of Maryland, Baltimore (S.C.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2021 Aug; Vol. 52 (8), pp. 2562-2570. Date of Electronic Publication: 2021 Jun 03.
DOI:	10.1161/STROKEAHA.120.032132
Abstrakt:	Background and Purpose: IV tPA (intravenous thrombolysis with alteplase) and mechanical thrombectomy (MT) utilization increased in acute ischemic stroke hospitalizations in the United States over the last decade. It is uncertain whether this increase occurred equally across all age, sex, and racial groups. Methods: Adult acute ischemic stroke hospitalizations (weighted n=4 442 657) contained in the 2008 to 2017 National Inpatient Sample were identified using International Classification of Diseases codes. Proportions of hospitalizations with IV tPA and MT were computed according to age, sex, and race. Joinpoint and multivariable-adjusted logistic regression models were used to evaluate trends over time. Results: Across this period, 32.4% of all hospitalizations were in patients ≥80 years, and 64.7% of these were women. IV tPA and MT use differed by age with highest proportion of utilization of both treatments in patients aged 18 to 39 years (IV tPA, 12.3%) and lowest percentage in patients aged ≥90 years (IV tPA, 7.9%). Utilization of both procedures increased over time in all age groups, but the pace of increase was faster in patients ≥90 years compared with patients aged 18 to 39 years (MT: odds ratio, 1.25 [95% CI, 1.20–1.35] per unit increase in year, P interaction <0.001). Frequency of utilization of IV tPA and MT was lower in Black patients compared with White patients in most age groups. Usage of both procedures increased over time in all races and after 2015, IV tPA utilization was >10% in all demographic subgroups except in Black patients 60 to 79 years and Black patients ≥80 years. Analysis of race-by-time interaction revealed the Black-vs-White treatment gaps for IV tPA (odds ratio, 1.02 [95% CI, 1.01–1.03]) and MT (odds ratio, 1.08 [95% CI,1.05–1.12]) declined over time (both P interaction <0.01). Sex-related differences in IV tPA use were noted, but this gap also declined over time. Conclusions: Age- and sex-related treatment gaps in IV tPA and MT reduced over the last decade. Racial disparity in IV tPA and MT utilization persists with particularly lower frequency of usage of both acute stroke treatments in Black patients compared with White patients, but race-associated treatment gaps also declined over time.
Databáze:	MEDLINE
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