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Comparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients With Acute Ischemic Stroke.
Abstract
Importance:Although overall stroke incidence and mortality in the United States is
improving, little is known about the characteristics and clinical outcomes of acute
ischemic stroke in Asian American individuals. Objective:To compare the characteristics,
care, and outcomes of Asian American and white patients with acute ischemic stroke.
Design, Setting, Participants:Retrospective analysis of Asian American and white patients
admitted with a primary diagnosis of acute ischemic stroke to hospitals participating
in the Get With The Guidelines-Stroke (GWTG-Stroke) program between April 1, 2004,
and July 31, 2016. The GWTG-Stroke database is a prospectively collected stroke quality
improvement registry sponsored by the American Heart Association/American Stroke Association.
Main Outcomes and Measures:Multivariable logistic regression models assessed the association
of Asian American race/ethnicity, clinical outcomes, and quality measures. Results:The
study population of 1 772 299 patients (mean [SD] age, 72.4 [14.2] years; 51.3% female)
consisted of 64 337 Asian American patients (3.6%) and 1 707 962 white patients (96.4%)
admitted to 2171 GWTG-Stroke hospitals with acute ischemic stroke. After adjustment
for patient and hospital variables, Asian American patients were seen with greater
stroke severity compared with white patients (National Institutes of Health Stroke
Scale [NIHSS] score ≥16) (odds ratio [OR], 1.35; 95% CI, 1.30-1.40; P < .001), manifested
higher in-hospital mortality (OR, 1.14; 95% CI, 1.09-1.19; P < .001), had longer length
of stay (OR, 1.17; 95% CI, 1.14-1.20; P < .001), and were less likely to ambulate
independently at discharge (OR, 0.84; 95% CI, 0.79-0.90; P < .001). Although Asian
American patients had fewer intravenous tissue plasminogen activator (IV tPA) administrations
than white patients (OR, 0.95; 95% CI, 0.91-0.98; P = .003), they had more symptomatic
hemorrhage after tPA (OR, 1.36; 95% CI, 1.20-1.55; P < .001) and overall post-tPA
complications (OR, 1.31; 95% CI, 1.18-1.46; P < .001). Asian American patients had
better quality measure adherence overall than white patients, including rehabilitation
(OR, 1.27; 95% CI, 1.18-1.36; P < .001), door to tPA within 60 minutes (OR, 1.14;
95% CI, 1.06-1.22; P < .001), and intensive statin therapy (OR, 1.14; 95% CI, 1.10-1.18;
P < .001). After adjustment for stroke severity, Asian American patients had lower
in-hospital mortality than white patients (OR, 0.95; 95% CI, 0.91-0.99; P = .008).
Conclusions and Relevance:Asian American patients manifested more severe ischemic
strokes, were less likely to receive IV tPA, and had worse functional outcomes than
white patients. These findings warrant additional research toward improving clinical
outcomes for Asian American patients with acute ischemic stroke.
Type
Journal articleSubject
HumansBrain Ischemia
Intracranial Hemorrhages
Tissue Plasminogen Activator
Fibrinolytic Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Treatment Outcome
Thrombolytic Therapy
Patient Discharge
Severity of Illness Index
Hospital Mortality
Multivariate Analysis
Logistic Models
Retrospective Studies
Aged
Aged, 80 and over
Middle Aged
Asian Americans
European Continental Ancestry Group
Quality of Health Care
United States
Female
Male
Stroke
Healthcare Disparities
Time-to-Treatment
Stroke Rehabilitation
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https://hdl.handle.net/10161/21621Published Version (Please cite this version)
10.1001/jamaneurol.2018.4410Publication Info
Song, Sarah; Liang, Li; Fonarow, Gregg C; Smith, Eric E; Bhatt, Deepak L; Matsouaka,
Roland A; ... Saver, Jeffrey L (2019). Comparison of Clinical Care and In-Hospital Outcomes of Asian American and White Patients
With Acute Ischemic Stroke. JAMA neurology, 76(4). pp. 430-439. 10.1001/jamaneurol.2018.4410. Retrieved from https://hdl.handle.net/10161/21621.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Roland Albert Matsouaka
Associate Professor of Biostatistics & Bioinformatics
Ying Xian
Adjunct Associate Professor in the Department of Neurology
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