Sex Disparities in Ischemic Stroke Care: FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities)

Negar Asdaghi, Jose G Romano, Kefeng Wang, Maria A. Ciliberti-Vargas, Sebastian Koch, Hannah Gardener, Chuanhui Dong, David Z. Rose, Salina P. Waddy, Mary Robichaux, Enid J. Garcia, Juan A. Gonzalez-Sanchez, W. Scott Burgin, Ralph L Sacco, Tatjana Rundek

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background and Purpose - Sex-specific disparities in stroke care including thrombolytic therapy and early hospital admission are reported. In a large registry of Florida and Puerto Rico hospitals participating in the Get With The Guidelines - Stroke program, we sought to determine sex-specific differences in ischemic stroke performance metrics and overall thrombolytic treatment. Methods - Around 51 317 (49% women) patients were included from 73 sites from 2010 to 2014. Multivariable logistic regression with generalized estimating equations evaluated sex-specific differences in the prespecified Get With The Guidelines - Stroke metrics for defect-free care in ischemic stroke, adjusting for age, race-ethnicity, insurance status, hospital characteristics, individual risk factors, and the presenting stroke severity. Results - As compared with men, women were older (73±15 versus 69±14 years; P<0.0001), more hypertensive (67% versus 63%, P<0.0001), and had more atrial fibrillation (19% versus 16%; P<0.0001). Defect-free care was slightly lower in women than in men (odds ratio, 0.96; 95% confidence interval, 0.93-1.00). Temporal trends in defect-free care improved substantially and similarly for men and women, with a 29% absolute improvement in women (P<0.0001) and 28% in men (P<0.0001), with P value of 0.13 for time-by-sex interaction. Women were less likely to receive thrombolysis (odds ratio, 0.92; 95% confidence interval, 0.86-0.99; P=0.02) and less likely to have a door-to-needle time <1 hour (odds ratio, 0.83; 95% confidence interval, 0.71-0.97; P=0.02) as compared with men. Conclusions - Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.

Original languageEnglish (US)
Pages (from-to)2618-2626
Number of pages9
JournalStroke
Volume47
Issue number10
DOIs
StatePublished - Oct 1 2016

Fingerprint

Puerto Rico
Stroke
Odds Ratio
Guidelines
Confidence Intervals
Sex Characteristics
Needles
Registries
Insurance Coverage
Thrombolytic Therapy
Atrial Fibrillation
Logistic Models
Observation

Keywords

  • Get With The Guidelines
  • National Institute of Neurological Disorders and Stroke
  • sex characteristics
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Sex Disparities in Ischemic Stroke Care : FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). / Asdaghi, Negar; Romano, Jose G; Wang, Kefeng; Ciliberti-Vargas, Maria A.; Koch, Sebastian; Gardener, Hannah; Dong, Chuanhui; Rose, David Z.; Waddy, Salina P.; Robichaux, Mary; Garcia, Enid J.; Gonzalez-Sanchez, Juan A.; Burgin, W. Scott; Sacco, Ralph L; Rundek, Tatjana.

In: Stroke, Vol. 47, No. 10, 01.10.2016, p. 2618-2626.

Research output: Contribution to journalArticle

Asdaghi, N, Romano, JG, Wang, K, Ciliberti-Vargas, MA, Koch, S, Gardener, H, Dong, C, Rose, DZ, Waddy, SP, Robichaux, M, Garcia, EJ, Gonzalez-Sanchez, JA, Burgin, WS, Sacco, RL & Rundek, T 2016, 'Sex Disparities in Ischemic Stroke Care: FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities)', Stroke, vol. 47, no. 10, pp. 2618-2626. https://doi.org/10.1161/STROKEAHA.116.013059
Asdaghi, Negar ; Romano, Jose G ; Wang, Kefeng ; Ciliberti-Vargas, Maria A. ; Koch, Sebastian ; Gardener, Hannah ; Dong, Chuanhui ; Rose, David Z. ; Waddy, Salina P. ; Robichaux, Mary ; Garcia, Enid J. ; Gonzalez-Sanchez, Juan A. ; Burgin, W. Scott ; Sacco, Ralph L ; Rundek, Tatjana. / Sex Disparities in Ischemic Stroke Care : FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). In: Stroke. 2016 ; Vol. 47, No. 10. pp. 2618-2626.
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abstract = "Background and Purpose - Sex-specific disparities in stroke care including thrombolytic therapy and early hospital admission are reported. In a large registry of Florida and Puerto Rico hospitals participating in the Get With The Guidelines - Stroke program, we sought to determine sex-specific differences in ischemic stroke performance metrics and overall thrombolytic treatment. Methods - Around 51 317 (49{\%} women) patients were included from 73 sites from 2010 to 2014. Multivariable logistic regression with generalized estimating equations evaluated sex-specific differences in the prespecified Get With The Guidelines - Stroke metrics for defect-free care in ischemic stroke, adjusting for age, race-ethnicity, insurance status, hospital characteristics, individual risk factors, and the presenting stroke severity. Results - As compared with men, women were older (73{\^A}±15 versus 69{\^A}±14 years; P<0.0001), more hypertensive (67{\%} versus 63{\%}, P<0.0001), and had more atrial fibrillation (19{\%} versus 16{\%}; P<0.0001). Defect-free care was slightly lower in women than in men (odds ratio, 0.96; 95{\%} confidence interval, 0.93-1.00). Temporal trends in defect-free care improved substantially and similarly for men and women, with a 29{\%} absolute improvement in women (P<0.0001) and 28{\%} in men (P<0.0001), with P value of 0.13 for time-by-sex interaction. Women were less likely to receive thrombolysis (odds ratio, 0.92; 95{\%} confidence interval, 0.86-0.99; P=0.02) and less likely to have a door-to-needle time <1 hour (odds ratio, 0.83; 95{\%} confidence interval, 0.71-0.97; P=0.02) as compared with men. Conclusions - Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.",
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T1 - Sex Disparities in Ischemic Stroke Care

T2 - FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities)

AU - Asdaghi, Negar

AU - Romano, Jose G

AU - Wang, Kefeng

AU - Ciliberti-Vargas, Maria A.

AU - Koch, Sebastian

AU - Gardener, Hannah

AU - Dong, Chuanhui

AU - Rose, David Z.

AU - Waddy, Salina P.

AU - Robichaux, Mary

AU - Garcia, Enid J.

AU - Gonzalez-Sanchez, Juan A.

AU - Burgin, W. Scott

AU - Sacco, Ralph L

AU - Rundek, Tatjana

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Background and Purpose - Sex-specific disparities in stroke care including thrombolytic therapy and early hospital admission are reported. In a large registry of Florida and Puerto Rico hospitals participating in the Get With The Guidelines - Stroke program, we sought to determine sex-specific differences in ischemic stroke performance metrics and overall thrombolytic treatment. Methods - Around 51 317 (49% women) patients were included from 73 sites from 2010 to 2014. Multivariable logistic regression with generalized estimating equations evaluated sex-specific differences in the prespecified Get With The Guidelines - Stroke metrics for defect-free care in ischemic stroke, adjusting for age, race-ethnicity, insurance status, hospital characteristics, individual risk factors, and the presenting stroke severity. Results - As compared with men, women were older (73±15 versus 69±14 years; P<0.0001), more hypertensive (67% versus 63%, P<0.0001), and had more atrial fibrillation (19% versus 16%; P<0.0001). Defect-free care was slightly lower in women than in men (odds ratio, 0.96; 95% confidence interval, 0.93-1.00). Temporal trends in defect-free care improved substantially and similarly for men and women, with a 29% absolute improvement in women (P<0.0001) and 28% in men (P<0.0001), with P value of 0.13 for time-by-sex interaction. Women were less likely to receive thrombolysis (odds ratio, 0.92; 95% confidence interval, 0.86-0.99; P=0.02) and less likely to have a door-to-needle time <1 hour (odds ratio, 0.83; 95% confidence interval, 0.71-0.97; P=0.02) as compared with men. Conclusions - Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.

AB - Background and Purpose - Sex-specific disparities in stroke care including thrombolytic therapy and early hospital admission are reported. In a large registry of Florida and Puerto Rico hospitals participating in the Get With The Guidelines - Stroke program, we sought to determine sex-specific differences in ischemic stroke performance metrics and overall thrombolytic treatment. Methods - Around 51 317 (49% women) patients were included from 73 sites from 2010 to 2014. Multivariable logistic regression with generalized estimating equations evaluated sex-specific differences in the prespecified Get With The Guidelines - Stroke metrics for defect-free care in ischemic stroke, adjusting for age, race-ethnicity, insurance status, hospital characteristics, individual risk factors, and the presenting stroke severity. Results - As compared with men, women were older (73±15 versus 69±14 years; P<0.0001), more hypertensive (67% versus 63%, P<0.0001), and had more atrial fibrillation (19% versus 16%; P<0.0001). Defect-free care was slightly lower in women than in men (odds ratio, 0.96; 95% confidence interval, 0.93-1.00). Temporal trends in defect-free care improved substantially and similarly for men and women, with a 29% absolute improvement in women (P<0.0001) and 28% in men (P<0.0001), with P value of 0.13 for time-by-sex interaction. Women were less likely to receive thrombolysis (odds ratio, 0.92; 95% confidence interval, 0.86-0.99; P=0.02) and less likely to have a door-to-needle time <1 hour (odds ratio, 0.83; 95% confidence interval, 0.71-0.97; P=0.02) as compared with men. Conclusions - Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.

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KW - National Institute of Neurological Disorders and Stroke

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