Study finds whites more likely to get key stroke treatment than blacks

Thursday, May 3rd 2001, 12:00 am
By: News On 6

DALLAS (AP) _ Whites are five times more likely than blacks to receive emergency clot-busting treatment for stroke, researchers found.

Only 1.1 percent of blacks received the drug TPA in a study of the nation's top hospitals, compared with 5.3 percent of whites. Researchers said a large racial disparity persisted even after they took into account age, gender, type of insurance and severity of the stroke.

One of the study's authors, Dr. S. Claiborne Johnston, said more research is required to learn why treatment differs by race.

``We have to consider the possibility that racism is contributing,'' said Johnston, assistant professor of neurology at the University of California at San Francisco.

In general, researchers found low overall use of TPA _ the only Food and Drug Administration-approved clot-buster for strokes caused by blood clots. Among all patients who arrived at the hospital within two hours of the onset of symptoms, fewer than a quarter received the drug.

The study was published in the May issue of the American Heart Association journal Stroke.

A stroke is a lack of blood flow that kills brain tissue. Strokes are occasionally caused by a burst blood vessel. But the vast majority are ischemic strokes, which happen when arteries feeding the brain are blocked by a clot.

TPA has revolutionized ischemic stroke care. But the drug must be given within three hours of the first symptoms and raises the risk of bleeding in the brain _ an effect that makes some doctors reluctant to use it.

In the new study, researchers reviewed records at 42 U.S. academic medical centers of 1,195 ischemic stroke patients treated in 1999.

Even among the 189 patients considered good candidates for TPA _ those who arrived at the hospital within three hours and had no other conditions that made treatment unsafe _ whites were three times more likely than blacks to get the drug. No blacks were documented as having refused the drug, while three whites were.

Johnston said that if race is a factor, it is a subtle one. He said other studies have shown that blacks are more likely to decline risky medical treatments.

``I think doctors internalize that. Because of that, they may not be offering the drug to African-Americans as frequently, thinking that they may not accept the risk,'' Johnston said.

Other researchers urged caution in interpreting the results.

Dr. Larry Goldstein, director of the Center for Cerebral Vascular Disease at Duke University, noted that the study looked at medical records after the fact and said that could obscure some explanations. For example, he said, TPA may have been offered and declined without the records reflecting that.

``Some people might write that down in their notes,'' Goldstein said. ``Other people may just say, `They don't want it. Let's move on,' and not take the time to write it all down.''

Dr. Mark Alberts, professor of neurology at Northwestern University Medical School, said various factors that were not statistically significant on their own could have combined to create at least some of the disparity. He noted, for example, that blacks tended to arrive later at the hospital after symptoms began and more frequently had conditions that made treatment unsafe.