Racial and ethnic disparities in the use of intravenous recombinant tissue plasminogen activator and outcomes for acute ischemic stroke

J Stroke Cerebrovasc Dis. 2013 Feb;22(2):154-60. doi: 10.1016/j.jstrokecerebrovasdis.2011.07.003. Epub 2011 Dec 11.


Racial and ethnic disparities in acute stroke care in the United States have been previously reported. This study investigated possible racial and ethnic disparities in the administration and outcome of recombinant tissue plasminogen activator (rtPA) therapy for acute ischemic stroke in whites, blacks, Hispanics, and Asian/Pacific Islanders. Using the National Inpatient Sample for 2001-2008, we selected patients with a primary diagnosis of acute ischemic stroke who received treatment with rtPA. Patient data were stratified by race (white, black, Hispanic, and Asian/Pacific Islander). We analyzed the association of patient race on rtPA utilization rate, in-hospital morbidity (ie, discharge to long-term facility), intracranial hemorrhage (ICH) rate, and in-hospital mortality. We performed a multivariate logistic regression analysis to determine independent predictors of poor outcomes. White patients had a higher rate of tPA utilization than black and Hispanic patients (2.3% vs 1.8% and 2.0%, respectively; P < .0001 for both groups). There was no difference in the rate of tPA utilization between whites and Asian/Pacific Islanders (2.3% vs 2.2% P = .07). Multivariate analysis of morbidity, mortality, and ICH rates found that Asian/Pacific Islanders had significantly higher rates of mortality (odds ratio, 1.22, 95% confidence interval, 1.03-1.44; P = .02) and ICH (odds ratio, 2.01; 95% confidence interval, 1.91-2.11; P < .0001) compared with whites. rtPA utilization was greater in white and Asian/Pacific Islander patients than in black and Hispanic patients. Asian/Pacific Islander race was associated with increased risk of ICH and mortality after rtPA administration.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Black People / statistics & numerical data
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / ethnology*
  • Brain Ischemia / mortality
  • Comorbidity
  • Ethnicity / statistics & numerical data*
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Injections, Intravenous
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Native Hawaiian or Other Pacific Islander / statistics & numerical data
  • Outcome Assessment, Health Care
  • Recombinant Proteins / administration & dosage
  • Stroke / drug therapy*
  • Stroke / ethnology*
  • Stroke / mortality
  • Tissue Plasminogen Activator / administration & dosage*
  • White People / statistics & numerical data


  • Fibrinolytic Agents
  • Recombinant Proteins
  • Tissue Plasminogen Activator