There are few studies on the effect of multiple vulnerabilities to health disparities identified in the AHRQ 2012 report on secondary stroke prevention. We examined the effects of 5 vulnerability domains (race, age, region, health insurance and income) on the prescription of secondary stroke prevention medications at discharge following hospitalization for an acute ischemic stroke (AIS) in a large, national cohort of patients admitted to unselected hospitals.
Methods:
We conducted a retrospective review of admissions for AIS between 2003-2012 within the REGARDS cohort. Discharge medications, insurance status, and age at time of stroke event were obtained from hospital records. Race, region and income < $20,000 were obtained from REGARDS baseline data. We constructed a vulnerability score (v score) range from 0-5, with 0 indicating no vulnerability. We examined the prevalence of each discharge medication by each vulnerability domain, score category, and by overall score using Poisson regression with a robust variance estimator.
Results:
664 participants met the inclusion criteria. 132 (20%) of the study participants had ≥ 3 vulnerabilities (v score of 3-5). Participants with ≥ 3 vulnerabilities were more likely to be black (80.3%), > 75 years old (63.6%), and to report income < $20,000 (67.4%). The prevalence of receiving antithrombotic prescriptions at discharge was significantly lower in participants with ≥ 3 vulnerability domains (PR: 0.90 [95% CI: 0.82, 0.99]). The prevalence of receiving antithrombotic prescriptions was also inversely associated with a per point increase of the v score (PR: 0.96 [95% CI: 0.93, 0.99]), as were lipid- lowering prescriptions at discharge (PR: 0.95 [CI: 0.90, 0.99]). There was a non-statistically significant inverse association between ACEi/ARB prescriptions at discharge and having multiple vulnerabilities, including for 2 vulnerabilities (PR: 0.93 [CI: 0.80, 1.09]) and for ≥ 3 vulnerabilities (PR: 0.84 [CI: 0.69, 1.01]).
Conclusion:
The presence of multiple vulnerabilities was associated with lower adherence by healthcare providers to secondary stroke prevention recommendations for discharge prescriptions.