Are health care disparities tied to stroke treatments?

For people with stroke, social factors such as race, neighborhood and insurance, may be linked to whether they receive treatment, according to a study published in the October 16, 2024, online issue of Neurology, the medical journal of the American Academy of Neurology.

The study looked at people with ischemic stroke, which is caused by a blockage of blood flow to the brain and is the most common type of stroke. It also looked at two treatments for stroke: thrombolytic therapy, or clot-busting drugs; and thrombectomy, a procedure that removes blood clots from arteries to restore blood flow.

“Social and economic disparities are tied to poor outcomes in stroke,” said study author Chathurika Samudani Dhanasekara, MD, Ph.D., of Texas Tech University Health Sciences Center in Lubbock, Texas. “While some have suggested that this link is driven by the higher rate of stroke in people facing social and economic disparities, others have raised concerns regarding inequalities in stroke care. Our study found that these disparities continue to be a driving force of access to treatment.”

The study involved 139,852 people with stroke. For race and ethnicity, 67% of participants were white, 17% were Black and 25% were Hispanic.

Of the group, 16,831 people, or 12%, received clot-busting drugs and 5,951 people, or 4%, received a thrombectomy.

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 five groups.

Among 23,152 Black people, 2,559 people, or 11%, received clot-busting drugs and 784 people, or 3%, received a thrombectomy. Among 35,056 Hispanic people, 4,275 people, or 13%, received clot-busting drugs and 1,553 people, or 4%, received a thrombectomy. Among the 93,928 white people, 11,369 people, or 12%, received clot-busting drugs and 3,939 people, or 4%, received a thrombectomy.

After adjusting for factors such as diabetes, obesity and high blood pressure, researchers found that Black people were 20% less likely to receive clot-busting drugs and 25% less likely to receive a thrombectomy than white people. Hispanic people were 6% less likely to receive clot-busting drugs and 8% less likely to receive a thrombectomy than white people.

When looking at the Social Vulnerability Index, those with the highest disadvantage were 7% less likely to receive clot-busting drugs and 26% less likely to receive thrombectomy than those with the least disadvantage.

When looking at insurance coverage, researchers found that those who were uninsured were 12% less likely to receive clot-busting drugs than those with private insurance.

“More studies are needed to understand the specific causes of the problem driving these disparities at the national and global level and to improve access to care for all individuals, regardless of their background,” said Dhanasekara.

A limitation of the study was that this study looked only at people in Texas, which has the highest percentage of uninsured people compared with other US states and the largest rural Hispanic population. So, the results may not be generalizable to other locations.