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A study examining race and gender disparities in acute outcomes and treatment of acute ischemic stroke patients with diabetes reveals that minority groups and women experience worse outcomes and are less likely to receive evidence-based reperfusion therapy compared to White patients and men.

  • This is the first study to concurrently examine race and sex differences in post-stroke outcomes in diabetic patients.
  • Minority populations and women had worse in-hospital outcomes than White patients and men.
  • African American and Hispanic patients were less likely to receive evidence-based reperfusion therapy.
  • Disparities in outcomes are not entirely driven by disparities in treatment.

Acute ischemic stroke (AIS) poses a significant risk to those with diabetes mellitus (DM), with racial minority groups disproportionately affected. A recent study, published in Clinical Neurology and Neurosurgery, sought to determine whether racial and gender disparities exist in acute outcomes and treatments for patients with AIS and comorbid DM. The study also examined potential differences in the administration of evidence-based reperfusion therapy.

Exploring Acute Outcomes With a National Inpatient Sample Study

By analyzing AIS admissions from the US National Inpatient Sample (NIS) between January 2016 and December 2018, researchers assessed the association between race, sex, and differences in in-hospital outcomes and treatment methods. These outcomes included mortality, hospitalization lasting more than 4 days, routine discharge, and stroke severity.

Disparities in Outcomes and Treatment

In comparison to White patients, African American patients had lower odds of in-hospital mortality but were more likely to have a prolonged hospital stay, be discharged to locations other than home, and experience moderate/severe stroke. Similarly, Hispanic patients had higher odds of longer hospital stays and severe stroke. Both African American and Hispanic patients were less likely to receive thrombectomy. Women, compared to men, faced an increased likelihood of in-hospital mortality.

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Implications for Clinical Practice 

These findings indicate the presence of racial and gender disparities in both evidence-based reperfusion therapy and in-hospital outcomes amongst patients with AIS and diabetes. These disparities are not fully attributable to differences in treatment, indicating a complex, multifactorial problem likely involving unmeasured environmental, societal, genetic, and clinical management factors.

For clinicians, understanding these disparities is important for personalized patient management strategies. Efforts must be made to address these disparities and reduce the risk of adverse outcomes in women and African American patients. Further research, focusing on eligible patient cohorts for revascularization and patient consent, may help clarify these disparities and improve targeted intervention strategies.

Source:

Thuemmler, R. J., Pana, T. A., Mohamed, M. O., Poobalan, A., Mamas, M. A., & Myint, P. K. (2023). Race and Sex Disparities in Acute Outcomes of Patients with Acute Ischemic Stroke and Diabetes Mellitus. A National Inpatient Sample Study. Clinical Neurology and Neurosurgery, 107747. https://doi.org/10.1016/j.clineuro.2023.107747