Study finds link between healthcare inequities, stroke treatment

LOS ANGELES: People with stroke may obtain treatment with clot-busting medications based on social characteristics like education, neighbourhood, and employment, according to a new study.

The study focused on persons suffering from ischemic stroke, the most common type of stroke caused by a stoppage in blood flow to the brain.

"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, MD, PhD, MPhil, of Texas Tech University Health Sciences Center in Lubbock and a member of the American Academy of Neurology.

"Our study found that several 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 ischemic stroke identified through public health records in Texas. For race and ethnicity, 67% of participants were white, 18 per cent were Black and 27 per cent were Hispanic, with some participants having more than one race and ethnicity.

Researchers determined that 7,198, or 11 per cent, received clot-busting drugs.

Researchers then looked at social factors that may impact a person's health, such as income, education, housing, and access to health services. To rank participants based on these factors, they used U.S. Census data and applied a measure called the Social Vulnerability Index. They divided participants 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 clot-busting drugs.

After adjusting for age, sex and education, 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, Black people were 10 per cent less likely to receive this therapy than white people. Hispanic people were 7 per cent less likely to receive this therapy than non-Hispanic people.

When looking at insurance coverage, researchers found that those who were on Medicare, Medicaid or Veterans Assistance and those who were uninsured were 23 per cent and 10 per cent, respectively, less likely to receive clot-busting drugs than those with private insurance.

After looking at location, 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 health care 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 health care system, and stroke outcomes. Finding new approaches to address these social factors is imperative for improving equity in stroke care and recovery."