scholarly journals Ten-Year Trend in Age, Sex, and Racial Disparity in tPA (Alteplase) and Thrombectomy Use Following Stroke in the United States

Stroke ◽  
2021 ◽  
Vol 52 (8) ◽  
pp. 2562-2570
Author(s):  
Fadar Oliver Otite ◽  
Vasu Saini ◽  
Nicole Beaton Sur ◽  
Smit Patel ◽  
Richa Sharma ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Racial Disparity ◽  
Odds Ratio ◽  
Age Groups ◽  
The United States ◽  
Black Patients ◽  
Treatment Gaps ◽  
Over Time ◽  
Iv Tpa

Background and Purpose: IV tPA (intravenous thrombolysis with alteplase) and mechanical thrombectomy (MT) utilization increased in acute ischemic stroke hospitalizations in the United States over the last decade. It is uncertain whether this increase occurred equally across all age, sex, and racial groups. Methods: Adult acute ischemic stroke hospitalizations (weighted n=4 442 657) contained in the 2008 to 2017 National Inpatient Sample were identified using International Classification of Diseases codes. Proportions of hospitalizations with IV tPA and MT were computed according to age, sex, and race. Joinpoint and multivariable-adjusted logistic regression models were used to evaluate trends over time. Results: Across this period, 32.4% of all hospitalizations were in patients ≥80 years, and 64.7% of these were women. IV tPA and MT use differed by age with highest proportion of utilization of both treatments in patients aged 18 to 39 years (IV tPA, 12.3%) and lowest percentage in patients aged ≥90 years (IV tPA, 7.9%). Utilization of both procedures increased over time in all age groups, but the pace of increase was faster in patients ≥90 years compared with patients aged 18 to 39 years (MT: odds ratio, 1.25 [95% CI, 1.20–1.35] per unit increase in year, P interaction <0.001). Frequency of utilization of IV tPA and MT was lower in Black patients compared with White patients in most age groups. Usage of both procedures increased over time in all races and after 2015, IV tPA utilization was >10% in all demographic subgroups except in Black patients 60 to 79 years and Black patients ≥80 years. Analysis of race-by-time interaction revealed the Black-vs-White treatment gaps for IV tPA (odds ratio, 1.02 [95% CI, 1.01–1.03]) and MT (odds ratio, 1.08 [95% CI,1.05–1.12]) declined over time (both P interaction <0.01). Sex-related differences in IV tPA use were noted, but this gap also declined over time. Conclusions: Age- and sex-related treatment gaps in IV tPA and MT reduced over the last decade. Racial disparity in IV tPA and MT utilization persists with particularly lower frequency of usage of both acute stroke treatments in Black patients compared with White patients, but race-associated treatment gaps also declined over time.

Abstract WMP94: Temporal Trends in Racial, Age, and Sex-Specific Utilization of Decompressive Hemicraniectomy Among Acute Ischemic Stroke Patients in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sai P Polineni ◽  
Fadar O Otite ◽  
Seemant Chaturvedi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
Age Groups ◽  
The United States ◽  
Decompressive Hemicraniectomy ◽  
Study Results ◽  
Over Time ◽  
Age And Sex

Background: The aim of this study is to evaluate current trends in racial, age, and sex-specific utilization of decompressive hemicraniectomy (HC) in acute ischemic stroke (AIS) patients in the United States over the last decade. Methods: All adult patients with a diagnosis of AIS were identified from the 2004-2015 Nationwide Inpatient Sample (weighted N=4,792,428) using International Classification of Diseases Ninth revision (ICD-9) codes. Proportion of patients undergoing HC in various age, race, and sex groups were ascertained using ICD-9 procedural codes. Temporal trends were mapped by year in order to track changes in utilization over time. Analysis of utilization disparities and trends within age, sex, and race subgroups was conducted via multivariate logistic regression. Results: Of all eligible AIS patients from 2004-2015, 0.25% underwent HC (.08 in 2004 to .46 in 2015). Increased utilization over time was seen in both men (.13 to .57) and women (.08 to .54), with women showing comparable odds of utilization to men [OR: 0.95 (95% CI: .87-1.04, p=0.27)]. Similarly, increased utilization trends were seen in all age groups (Figure 1) with the highest rates in the 18-39 subgroup (1.41%). Compared to trends in this younger subgroup (.43 to 2.12), patients aged 60-79 experienced a similar overall increase but at lower utilization rates (.06 to .37). Compared to white patients in multivariate models, blacks did not show significant differences in odds of HC [1.09 (.96-1.24, p=0.20)], while patients from Hispanic [1.25 (1.03-1.51, p=0.02)] and other [1.26 (1.04-1.52, p=0.02)] race-ethnic groups showed increased odds. Conclusions: From 2004-2015, hemicraniectomy rates have seen substantial increases in all age, sex, and race groups. The increasing rates of hemicraniectomies among those over age 60 suggest that there has been at least partial acceptance of DESTINY 2 study results.

Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention

Stroke ◽  
2021 ◽  
Author(s):  
Ying Xian ◽  
Haolin Xu ◽  
Eric E. Smith ◽  
Jeffrey L. Saver ◽  
Mathew J. Reeves ◽  
...  
Keyword(s):  
United States ◽  
Quality Improvement ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Phase I ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
The United States

Background and Purpose: The benefits of tPA (tissue-type plasminogen activator) in acute ischemic stroke are time-dependent. However, delivery of thrombolytic therapy rapidly after hospital arrival was initially occurring infrequently in hospitals in the United States, discrepant with national guidelines. Methods: We evaluated door-to-needle (DTN) times and clinical outcomes among patients with acute ischemic stroke receiving tPA before and after initiation of 2 successive nationwide quality improvement initiatives: Target: Stroke Phase I (2010–2013) and Target: Stroke Phase II (2014–2018) from 913 Get With The Guidelines-Stroke hospitals in the United States between April 2003 and September 2018. Results: Among 154 221 patients receiving tPA within 3 hours of stroke symptom onset (median age 72 years, 50.1% female), median DTN times decreased from 78 minutes (interquartile range, 60–98) preintervention, to 66 minutes (51–87) during Phase I, and 50 minutes (37–66) during Phase II ( P <0.001). Proportions of patients with DTN ≤60 minutes increased from 26.4% to 42.7% to 68.6% ( P <0.001). Proportions of patients with DTN ≤45 minutes increased from 10.1% to 17.7% to 41.4% ( P <0.001). By the end of the second intervention, 75.4% and 51.7% patients achieved 60-minute and 45-minute DTN goals. Compared with the preintervention period, hospitals during the second intervention period (2014–2018) achieved higher rates of tPA use (11.7% versus 5.6%; adjusted odds ratio, 2.43 [95% CI, 2.31–2.56]), lower in-hospital mortality (6.0% versus 10.0%; adjusted odds ratio, 0.69 [0.64–0.73]), fewer bleeding complication (3.4% versus 5.5%; adjusted odds ratio, 0.68 [0.62–0.74]), and higher rates of discharge to home (49.6% versus 35.7%; adjusted odds ratio, 1.43 [1.38–1.50]). Similar findings were found in sensitivity analyses of 185 501 patients receiving tPA within 4.5 hours of symptom onset. Conclusions: A nationwide quality improvement program for acute ischemic stroke was associated with substantial improvement in the timeliness of thrombolytic therapy start, increased thrombolytic treatment, and improved clinical outcomes.

scholarly journals Trends in incidence and epidemiologic characteristics of cerebral venous thrombosis in the United States

Neurology ◽  
2020 ◽  
Vol 95 (16) ◽  
pp. e2200-e2213 ◽  
Author(s):  
Fadar Oliver Otite ◽  
Smit Patel ◽  
Richa Sharma ◽  
Pushti Khandwala ◽  
Devashish Desai ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
Venous Thrombosis ◽  
Cerebral Venous Thrombosis ◽  
Census Data ◽  
Age Groups ◽  
The United States ◽  
Joinpoint Regression ◽  
Over Time ◽  
Age And Sex

ObjectiveTo test the hypothesis that race-, age-, and sex-specific incidence of cerebral venous thrombosis (CVT) has increased in the United States over the last decade.MethodsIn this retrospective cohort study, validated ICD codes were used to identify all new cases of CVT (n = 5,567) in the State Inpatients Databases (SIDs) of New York and Florida (2006–2016). A new CVT case was defined as first hospitalization for CVT in the SID without prior CVT hospitalization. CVT counts were combined with annual Census data to compute incidence. Joinpoint regression was used to evaluate trends in incidence over time.ResultsFrom 2006 to 2016, annual age- and sex-standardized incidence of CVT in cases per 1 million population ranged from 13.9 to 20.2, but incidence varied significantly by sex (women 20.3–26.9, men 6.8–16.8) and by age/sex (women 18–44 years of age 24.0–32.6, men 18–44 years of age 5.3–12.8). Incidence also differed by race (Blacks: 18.6–27.2; Whites: 14.3–18.5; Asians: 5.1–13.8). On joinpoint regression, incidence increased across 2006 to 2016, but most of this increase was driven by an increase in all age groups of men (combined annualized percentage change [APC] 9.2%, p < 0.001), women 45 to 64 years of age (APC 7.8%, p < 0.001), and women ≥65 years of age (APC 7.4%, p < 0.001). Incidence in women 18 to 44 years of age remained unchanged over time.ConclusionCVT incidence is disproportionately higher in Blacks compared to other races. New CVT hospitalizations increased significantly over the last decade mainly in men and older women. Further studies are needed to determine whether this increase represents a true increase from changing risk factors or an artifactual increase from improved detection.

scholarly journals Contact surveys reveal heterogeneities in age-group contributions to SARS-CoV-2 dynamics in the United States

2021 ◽  
Author(s):  
Taylor Chin ◽  
Dennis M. Feehan ◽  
Caroline O. Buckee ◽  
Ayesha S. Mahmud
Keyword(s):  
United States ◽  
Age Groups ◽  
The United States ◽  
Contact Rate ◽  
Age Group ◽  
Contact Rates ◽  
Contact Patterns ◽  
Age Structured ◽  
The Impact ◽  
Over Time

SARS-CoV-2 is spread primarily through person-to-person contacts. Quantifying population contact rates is important for understanding the impact of physical distancing policies and for modeling COVID-19, but contact patterns have changed substantially over time due to shifting policies and behaviors. There are surprisingly few empirical estimates of age-structured contact rates in the United States both before and throughout the COVID-19 pandemic that capture these changes. Here, we use data from six waves of the Berkeley Interpersonal Contact Survey (BICS), which collected detailed contact data between March 22, 2020 and February 15, 2021 across six metropolitan designated market areas (DMA) in the United States. Contact rates were low across all six DMAs at the start of the pandemic. We find steady increases in the mean and median number of contacts across these localities over time, as well as a greater proportion of respondents reporting a high number of contacts. We also find that young adults between ages 18 and 34 reported more contacts on average compared to other age groups. The 65 and older age group consistently reported low levels of contact throughout the study period. To understand the impact of these changing contact patterns, we simulate COVID-19 dynamics in each DMA using an age-structured mechanistic model. We compare results from models that use BICS contact rate estimates versus commonly used alternative contact rate sources. We find that simulations parameterized with BICS estimates give insight into time-varying changes in relative incidence by age group that are not captured in the absence of these frequently updated estimates. We also find that simulation results based on BICS estimates closely match observed data on the age distribution of cases, and changes in these distributions over time. Together these findings highlight the role of different age groups in driving and sustaining SARS-CoV-2 transmission in the U.S. We also show the utility of repeated contact surveys in revealing heterogeneities in the epidemiology of COVID-19 across localities in the United States.

scholarly journals Prevalence of Cervical Artery Dissection among Hospitalized Patients with Stroke by Age in a Nationally Representative Sample from the United States

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011420
Author(s):  
Yahya B. Atalay ◽  
Pirouz Piran ◽  
Abhinaba Chatterjee ◽  
Santosh Murthy ◽  
Babak B. Navi ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Representative Sample ◽  
Age Groups ◽  
Vertebral Artery Dissection ◽  
The United States ◽  
Artery Dissection ◽  
Cervical Artery Dissection ◽  
Cervical Artery ◽  
Nationally Representative

Objective:To test the hypothesis that the prevalence of cervical artery dissection remains constant across age groups, we evaluated the relationship between age and cervical artery dissection in patients with stroke using a Nationally Representative Sample from the United States.Methods:We used inpatient claims data included in the 2012-2015 releases of the National Inpatient Sample (NIS). We used validated ICD-9-CM codes to identify adults hospitalized with ischemic stroke and a concomitant diagnosis of carotid- or vertebral-artery dissection. Survey weights provided by the NIS and population estimates from the U.S. census were used to calculate nationally representative estimates. The chi-square test for trend was used to compare the prevalence of concomitant dissection among stroke hospitalizations across patient subgroups defined by age. Poisson regression and the Wald test for trend were used to evaluate whether the prevalence of hospitalizations for stroke and concomitant dissection per million person-years varied by age groups.Results:There were 17,320 (95% confidence interval [CI], 15,614-19,026) hospitalizations involving ischemic stroke and a concomitant dissection. The prevalence of dissection among stroke hospitalizations decreased across 10-year age groups from 7.2% (95% CI, 6.2%-8.1%) among persons younger than age 30 years to 0.2% (95% CI, 0.1%-0.2%) among persons older than age 80 years (P value for trend <0.001). However, the prevalence of hospitalizations for stroke and concomitant dissection increased from 5.4 (95% CI, 4.6-6.2) hospitalizations per million person-years among adults younger than age 30 to 24.4 (95% CI, 21.0-27.9) hospitalizations per million person-years among adults older than age 80 (P value for trend <0.01).Conclusions:In a nationally representative sample, the prevalence of hospitalizations for dissection-related stroke increased with age.

Acute Ischemic Stroke Interventions in the United States and Racial, Socioeconomic, and Geographic Disparities

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012943
Author(s):  
Adam de Havenon ◽  
Kevin Sheth ◽  
Karen C. Johnston ◽  
Alen Delic ◽  
Eric Stulberg ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Odds Ratio ◽  
Geographic Location ◽  
The United States ◽  
Multivariate Logistic Regression Model ◽  
Primary Study ◽  
Median Income ◽  
Full Cohort ◽  
Geographic Disparities

Background and ObjectivesIn ischemic stroke (IS) patients, intravenous alteplase (tPA) and endovascular thrombectomy (EVT) reduce long-term disability, but their utilization has not been fully optimized. Prior research has also demonstrated disparities in the use of tPA and EVT specific to sex, race/ethnicity, socioeconomic status, and geographic location. We sought to determine the utilization of tPA and EVT in the United States from 2016-18 and if disparities in utilization persist.MethodsThis is a retrospective, longitudinal analysis of the 2016-18 National Inpatient Sample.We included adult patients who had a primary discharge diagnosis of IS. The primary study outcomes were the proportions who received tPA or EVT. We fit a multivariate logistic regression model to our outcomes in the full cohort and also in the subset of patients who had an available baseline NIH Stroke Scale (NIHSS).ResultsThe full cohort after weighting included 1,439,295 IS patients. The proportion who received tPA increased from 8.8% in 2016 to 10.2% in 2018 (p<0.001); and who had EVT from 2.8% in 2016 to 4.9% in 2018 (p<0.001). Comparing Black to White patients, the odds ratio of receiving tPA was 0.82 (95% CI 0.79-0.86) and for having EVT was 0.75 (95% CI 0.70-0.81). Comparing patients with a median income in their ZIP code of ≤$37,999 to >$64,000, the odds ratio of receiving tPA was 0.81 (95% CI 0.78-0.85) and for having EVT was 0.84 (95% CI 0.77-0.91). Comparing patients living in a rural area to a large metro area, the odds ratio of receiving tPA was 0.48 (95% CI 0.44-0.52) and for having EVT was 0.92 (95% CI 0.81-1.05). These associations were largely maintained after adjustment for NIHSS, although the effect size changed for many of them. Contrary to prior reports with older datasets, sex was not consistently associated with tPA or EVT.ConclusionUtilization of tPA and EVT for IS in the United States increased from 2016 to 2018. Still, there are racial, socioeconomic, and geographic disparities in the accessibility of tPA and EVT for IS patients with important public health implications that require further study.

Nones of All Shapes and Sizes

2020 ◽  
pp. 58-91
Author(s):  
Joel Thiessen ◽  
Sarah Wilkins-Laflamme
Keyword(s):  
United States ◽  
Age Groups ◽  
The United States ◽  
Spiritual But Not Religious ◽  
Meaning Systems ◽  
Over Time

This chapter explores the internal diversity among religious nones when it comes to their beliefs, their meaning systems, and their religious or spiritual behaviors. This includes five subtypes of religious nones: involved seculars, inactive nonbelievers, inactive believers, spiritual but not religious, and involved believers. This chapter unpacks the size of these subgroups among religious nones in the United States and Canada, including how the sizes of these groups have changed over time. It also focuses on the composition of these subtypes based on age groups and regions. Ongoing space is devoted to what these subtypes look like when interviewees describe their own experiences.

Impact of age on outcomes in patients with hypertrophic cardiomyopathy: a nationwide inpatient database study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Jain ◽  
M.G Gupta ◽  
A.B Bansal ◽  
B.G Griffin ◽  
B.X Xu
Keyword(s):  
United States ◽  
Hypertrophic Cardiomyopathy ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Age Groups ◽  
Pacemaker Implantation ◽  
The United States ◽  
Age Group ◽  
Alcohol Septal Ablation ◽  
Septal Myectomy

Abstract Background Hypertrophic cardiomyopathy (HCM) is an inherited cardiovascular condition, associated with increased risk of premature adverse events. Once considered a disease of the young, it is increasingly being recognized in septuagenarians and octogenarians, with a few small-scale studies indicating that the risk of adverse cardiovascular outcomes may be lower in the older population. Purpose There are limited data regarding the outcomes of elderly patients with HCM. We therefore investigated a nationwide cohort in the United States to evaluate the pattern of disease presentation and outcomes of HCM patients, with a focus on the geriatric population. Methods The Nationwide Inpatient Sample (NIS) was queried to identify patients who were admitted for any cause with a concomitant diagnosis of HCM between 2011 and 2014 using ICD-9 (International Classification of Diseases-9th Edition-Clinical Modification) diagnosis code 425.1. All patients were further sub-categorized based on their age into those less than 65 years of age (representative of younger population), 66–75 years, 76–85 years and more than or equal to 86 years. We performed the Chi-squared tests for categorical variables and Mann–Whitney U tests for continuous variables. Multiple logistic regression was performed to assess the predictors of mortality. A two-tailed p-value of &lt;0.05 was considered to be significant. Results We identified 120,805 patients who were admitted with a diagnosis of HCM, of whom 46.4% were in the &lt;65 age group, 21.5% were in the 66–75 age group, 20.5% were in the 76–85 age group, and 11.5% were in the &gt;86 age group. The proportion of patients with ventricular fibrillation was lower (1.8% vs 1.0% vs 0.5% vs 0.1%, p&lt;0.01), whereas the proportion of patients undergoing permanent pacemaker placement was higher (1.2% vs 2.3% vs 3.7% vs 3.6%, p&lt;0.01) in successive age groups. The proportion of people undergoing operative procedures including septal myectomy (SM) (5.4% vs 4.5% vs 1.8% vs 0.2%, p-intervention &lt;0.01) and alcohol septal ablation (ASA) (3.2% vs 3.3% vs 1.9% vs 1.0%, p-intervention &lt;0.01) were lower in the advanced age groups when compared to the younger age groups. Pacemaker implantation (odds ratio (OR): 0.32, 95% confidence intervals (CIs): 0.20–0.50, p&lt;0.01) and implantable cardioverter defibrillator (ICD) placement (OR: 0.059, 95% CI: 0.024–0.144, p&lt;0.01) were found to be associated with decreased odds of in-hospital mortality across all age groups. Conclusion In a large nationwide cohort of HCM patients in the United States, a significant proportion of patients were septuagenarians and octogenarians. Fewer elderly patients with HCM underwent septal myectomy and alcohol septal ablation, while elderly patients underwent more pacemaker implants. A combination of reduced ventricular conduction abnormalities coupled with increased pacemaker implantation may be contributing to increased longevity in older HCM patients. Odds-ratio for predictors of mortality Funding Acknowledgement Type of funding source: None

Abstract WP212: Trends in Acute Ischemic Stroke Hospitalizations by Age Groups, Length of Stay, Mortality and Hospital Costs in the United States From 2000-2014

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Prashanth Rawla ◽  
Anantha Vellipuram ◽  
Rakesh Khatri ◽  
Alberto Maud ◽  
Gustavo J Rodriguez ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Hospital Costs ◽  
Age Groups ◽  
The United States
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