Study: Black patients with acute ischemic stroke less likely than white, Hispanic patients to undergo endovascular therapy

Black patients with acute ischemic stroke are 25% less likely to receive endovascular therapy compared to white or Hispanic stroke patients, according to research from The University of Texas Health Science Center at Houston (UTHealth Houston).

The study – led by Youngran Kim, PhD, postdoctoral research fellow in the Department of Neurology with McGovern Medical School at UTHealth Houston, and Sunil A. Sheth, MD, associate professor of neurology with the medical school – also found that this difference occurred despite the fact that Black patients present at facilities where endovascular therapy is available just as often as white patients.

The authors’ findings were published last month in Stroke, a peer-reviewed medical journal distributed on behalf of the American Heart Association.

“What this shows is that, even with advancements in technology and treatments, Black patients still have less of a chance of getting the most effective treatment,” Kim said. “Perhaps there is some institutionalized racism, but this persistent trend is something we need to address in the community and on the health care provider side.”

A data analysis of 40,814 acute ischemic stroke patients who were treated in Texas in 2019 revealed that, overall, rates of endovascular therapy were 4.1% among Black patients, 5.3% among white patients, and 4.8% among Hispanic patients, despite the fact that Black patients had similar admissions to endovascular therapy-performing hospitals and greater admissions to comprehensive stroke centers. The analysis of nationwide sample data also confirmed this finding of lower utilization of endovascular therapy for Black patients.

Even after adjusting for age, comorbidities, socioeconomic factors, and hospital type, Black patients were still less likely to undergo endovascular therapy than white or Hispanic patients, the researchers discovered.

“The key follow-up question to our study is why this is happening,” Sheth said. “These treatments are incredibly effective at reducing disability after stroke and saving lives, so it is important that we make sure that everyone suffering from stroke has access to these treatments.”

Acute ischemic stroke occurs when a blood clot blocks an artery leading to the brain, preventing the flow of blood to the brain. Endovascular therapy is known to be an effective treatment for this type of stroke, but it relies on specialized capabilities that are not available in every hospital where acute ischemic stroke is treated.

Sheth hopes these findings will give medical professionals a target goal to address the 25% disparity he and Kim found between Black and white patients in terms of who received the treatment.

Study co-authors include McGovern Medical School faculty and staff members Anjail Sharrief, MD, MPH, associate professor of neurology; Min Ji Kwak, MD, MS, DrPH, assistant professor of geriatric and palliative medicine; Swapnil Khose, neurology resident; Sergio Salazar-Marioni, research coordinator in the Department of Neurology; and Guo-Qiang Zhang, MS, PhD, professor of neurology.

Another co-author was Rania Abdelkhaleq, research assistant with the UTHealth Houston Institute for Stroke and Cerebrovascular Disease, where Sharrief serves as director of stroke prevention.

Zhang is also vice president and chief data scientist for UTHealth Houston, co-director of the Texas Institute for Restorative Neurotechnologies, and part-time professor for UTHealth Houston School of Biomedical Informatics. Salazar-Marioni is a student in the School of Biomedical Informatics.

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