White race was associated with higher odds of receiving intravenous thrombolysis compared to nonwhite race (adjusted OR 1.42; 95% CI 1.27-1.60), with disparities significantly greater among women.
Cohort (n=10,527)
Yes
Does race affect the receipt of reperfusion therapy and door-to-needle times in patients evaluated through a telestroke network?
Racial disparities in reperfusion therapy persist within a mature telestroke network and are significantly modified by sex, with more pronounced differences among women.
Effect estimate: adjusted OR 1.42 (95% CI 1.27-1.60)
Telestroke systems aim to standardize acute stroke care and reduce disparities in reperfusion therapy. Whether racial differences persist within mature telestroke networks and whether they are modified by sex-remains unclear. We conducted a retrospective cohort study of 10,527 patients evaluated through a statewide telestroke network from 2012 to 2022. Race was dichotomized as White or nonwhite. Outcomes included receipt of intravenous thrombolysis (tPA), mechanical thrombectomy (MT), and achievement of door-to-needle (DTN) times ≤60 and ≤45 minutes. Multivariable logistic regression adjusted for age, NIHSS, vascular comorbidities, and onset-to–emergency department arrival time. Race-by-sex interaction terms were tested. White patients had higher adjusted odds of receiving tPA (adjusted OR, 1.42; 95% CI, 1.27–1.60) and achieving DTN ≤60 minutes (adjusted OR, 1.49; 95% CI, 1.16–1.92) and ≤45 minutes (adjusted OR, 1.66; 95% CI, 1.27–2.20). Race was not associated with MT in pooled analysis (adjusted OR, 1.20; 95% CI, 0.96–1.51). Among thrombolysis-treated patients, although with similar symptom onset to ED door presentation, nonwhite patients experienced longer door-to-page (18 vs 15 minutes; P < .001) and door-to-needle times (61 vs 54 minutes; P < .001). Significant race-by-sex interactions were observed for tPA (interaction OR, 0.76; 95% CI, 0.61–0.94; P = .013) and MT (interaction OR, 0.61; 95% CI, 0.39–0.95; P = .029). In sex-stratified models, White race was associated with higher odds of tPA (adjusted OR, 1.64; 95% CI, 1.40–1.92) and MT (adjusted OR, 1.60; 95% CI, 1.14–2.25) among women, whereas associations were attenuated or not statistically significant among men. No race-by-sex interaction was observed for DTN benchmarks. Within a mature telestroke network, racial disparities in reperfusion therapy persist and are significantly modified by sex, with more pronounced differences among women. These findings suggest that inequities may arise during treatment decision-making rather than from delayed presentation and highlight the need for targeted equity-focused quality
Badu-Prempeh et al. (Wed,) conducted a cohort in acute stroke (n=10,527). White race vs. Nonwhite race was evaluated on Receipt of intravenous thrombolysis (tPA) (adjusted OR 1.42, 95% CI 1.27-1.60). White race was associated with higher odds of receiving intravenous thrombolysis compared to nonwhite race (adjusted OR 1.42; 95% CI 1.27-1.60), with disparities significantly greater among women.
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