Abstract WP265: Individual and System Contributions to Race and Sex Disparities in Thrombolysis Use for Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Roland Faigle ◽  
Victor C Urrutia ◽  
Lisa A Cooper ◽  
Rebecca F Gottesman
Keyword(s):  
Nationwide Inpatient Sample ◽  
White Women ◽  
Intravenous Thrombolysis ◽  
White Men ◽  
Minority Women ◽  
Stroke Patients ◽  
Race Disparities ◽  
Sex Disparities ◽  
Minority Men ◽  
Acute Stroke Therapy

Background: Intravenous thrombolysis (IVT) is the cornerstone of acute stroke therapy; however, is underutilized in minorities and women. In order to disentangle individual and system-based factors determining disparities in IVT use, we investigated race/sex differences in IVT utilization among hospitals serving varying proportions of minority patients. Methods: Inpatient admissions for ischemic stroke patients were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of minority patients admitted with stroke (<25% minority patients [“white hospitals”], 25-50% minority patients [“mixed hospitals”], or >50% minority patients [“minority hospitals”]). Logistic regression was used to evaluate the association between race/sex and IVT use within and between the different hospital strata. Results: A total of 337,201 stroke admissions were examined. Compared to white women, minority men, and minority women, the odds of IVT were highest for white men in any hospital strata; the odds of IVT for white men did not differ by hospital strata. For white women and minority men the odds of IVT were significantly lower in minority hospitals compared to white hospitals (OR 0.83, 95% CI 0.71-0.97, for white women; and OR 0.82, 95% CI 0.69-0.99, for minority men). The odds of IVT for minority women did not significantly differ by hospital strata. Race disparities in IVT use among women were observed in white hospitals (OR 0.88, 95% CI 0.78-0.99, in minority compared to white women), but not in minority hospitals (OR 0.94, 95% CI 0.82-1.09). Sex disparities in IVT use were observed among whites, but not minorities. Conclusion: Minority men and white women have significantly lower odds of IVT in minority hospitals compared to white hospitals. IVT use in white men does not differ by hospital strata.

The Earnings of Women and Ethnic Minorities, 1959–1979

ILR Review ◽  
1988 ◽  
Vol 41 (4) ◽  
pp. 530-546 ◽  
Author(s):  
Leonard A. Carlson ◽  
Caroline Swartz
Keyword(s):  
Asian Indian ◽  
White Women ◽  
Census Data ◽  
White Men ◽  
Racial Groups ◽  
Japanese Men ◽  
Men And Women ◽  
Earnings Gap ◽  
Minority Men ◽  
Annual Earnings

Using 1980 Census data, the authors present estimates of annual earnings equations for twelve ethnic and racial groups, by gender, for 1979, and compare their results with an earlier study's estimates for 1959 and 1969. All minority men and women except Asian Indian and Japanese men earned less than white men in the years for which data were available. The earnings gap for most groups of men and women, however, declined over those years, and the portion of that gap that might be assignable to discrimination (the unexplained “residual”) also declined. A notable exception was white women, whose mean earnings relative to white men's changed little between 1969 and 1979, even when corrected for differences in productive characteristics.

Perceived Discrimination in the Context of Multiple Group Memberships

2002 ◽  
Vol 13 (6) ◽  
pp. 557-560 ◽  
Author(s):  
Shana Levin ◽  
Stacey Sinclair ◽  
Rosemary C. Veniegas ◽  
Pamela L. Taylor
Keyword(s):  
Ethnic Minority ◽  
Gender Discrimination ◽  
White Women ◽  
White Men ◽  
Ethnic Discrimination ◽  
Double Jeopardy ◽  
Multiple Group ◽  
Men Of Color ◽  
Minority Men ◽  
Group Memberships

This study examined the joint impact of gender and ethnicity on expectations of general discrimination against oneself and one's group. According to the double-jeopardy hypothesis, women of color will expect to experience more general discrimination than men of color, White women, and White men because they belong to both a low-status ethnic group and a low-status gender group. Alternatively, the ethnic-prominence hypothesis predicts that ethnic-minority women will not differ from ethnic-minority men in their expectations of general discrimination because these expectations will be influenced more by perceptions of ethnic discrimination, which they share with men of color, than by perceptions of gender discrimination. All results were consistent with the ethnic-prominence hypothesis rather than the double-jeopardy hypothesis.

scholarly journals Gender and Racial Differentials in Promotions

2010 ◽  
Vol 64 (4) ◽  
pp. 593-619 ◽  
Author(s):  
Margaret Yap ◽  
Alison M. Konrad
Keyword(s):  
White Women ◽  
White Male ◽  
Racial Minorities ◽  
Minority Women ◽  
Visible Minority ◽  
Full Time ◽  
Organizational Hierarchy ◽  
Racial Differentials ◽  
Sticky Floor ◽  
Minority Men

Summary Using a proprietary dataset containing personnel records on over 22,000 full-time, non-unionized employees from a large Canadian firm with nationwide operations from 1996 to 2000, this paper explores the incidence of promotion for women and racial minorities. The findings show that women and racial minorities are less likely than their white male counterparts to be promoted. For both white women and minority women, the disadvantage is most severe at the lower rungs of the organizational hierarchy, lending support to the “sticky floor” hypothesis. Significant promotion disadvantages occur for white women, visible minority women, and visible minority men at the middle ranks of the organization, and visible minority men continue to experience a promotion disadvantage at the highest organizational levels.

Abstract TP200: African American Young Adults with Ischemic Stroke Have High Rates of Left Ventricular Hypertrophy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Yan Hou ◽  
Elizabeth Aradine ◽  
Kathleen Ryan ◽  
Prachi Mehndiratta ◽  
Seemant Chaturvedi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
White Women ◽  
Statistical Significance ◽  
Young Patients ◽  
White Men ◽  
Left Ventricular ◽  
Stroke Patients ◽  
History Of

Introduction: It is well known that African Americans (Afr-Am) have a higher prevalence of hypertension (HTN) compared to Whites. Few studies have compared Afr-Am and Whites for the prevalence of left ventricular hypertrophy (LVH; a marker of long-standing hypertension) in young ischemic stroke patients with and without a history of hypertension to assess hypertension severity and undiagnosed longstanding hypertension. We hypothesized that the prevalence of LVH by echocardiography would be higher in Afr-Am than in their White counterparts. Methods: We identified 1033 patients from a population-based case control study of young patients with first-time ischemic stroke (age 18 to 49 years old, enrolled from 1992-2006) from the Baltimore-Washington area. Patients (n=191, 16%) without an echocardiogram were excluded yielding an analysis sample of 842. Prevalence of LVH by echocardiography (Echo-LVH) were determined in those with and without a history of HTN, stratified by sex and race. Age-adjusted odds ratios and 95% confidence intervals comparing Afr-Am and Whites for the prevalence of Echo-LVH were calculated by logistic regression. Results: Of the 842 young stroke patients included in this study, the median age was 43.0, 55.2% were men, and 48.7 % were Afr-Am. Echo-LVH was common in young patients with ischemic stroke, even patients without a prior history of hypertension. Afr-Am women, both with and without a history of HTN, had higher age-adjusted prevalence of LVH than White women. Afr-Am men with no history of HTN had higher age-adjusted prevalence of Echo-LVH than White men. Afr-Am men with history of HTN had the highest prevalence of LVH, but the age-adjusted comparison with White men with HTN did not achieve statistical significance. Conclusions: The evidence suggests that Afr-Am have greater end organ damage from HTN, even among those who do not have an established diagnosis of HTN. These findings emphasize the need for earlier screening and treatment of HTN in young Afr-Am adults.

Factors Influencing Electrophysiologic Responsivity in Normal Adults

1965 ◽  
Vol 8 (4) ◽  
pp. 323-347
Author(s):  
Robert Goldstein ◽  
Benjamin RosenblÜt
Keyword(s):  
Conditioned Stimulus ◽  
White Light ◽  
Pure Tone ◽  
Alpha Rhythm ◽  
White Women ◽  
White Men ◽  
Inverse Relation ◽  
Factors Influencing ◽  
Electrodermal Responses ◽  
Normal Adults

Electrodermal and electroencephalic responsivity to sound and to light was studied in 96 normal-hearing adults in three separate sessions. The subjects were subdivided into equal groups of white men, white women, colored men, and colored women. A 1 000 cps pure tone was the conditioned stimulus in two sessions and white light was used in a third session. Heat was the unconditioned stimulus in all sessions. Previously, an inverse relation had been found in white men between the prominence of alpha rhythm in the EEG and the ease with which electrodermal responses could be elicited. This relation did not hold true for white women. The main purpose of the present study was to answer the following questions: (1) are the previous findings on white subjects applicable to colored subjects? (2) are subjects who are most (or least) responsive electrophysiologically on one day equally responsive (or unresponsive) on another day? and (3) are subjects who are most (or least) responsive to sound equally responsive (or unresponsive) to light? In general, each question was answered affirmatively. Other factors influencing responsivity were also studied.

Race Difference in Auditory Sensitivity

1964 ◽  
Vol 7 (4) ◽  
pp. 389-393 ◽  
Author(s):  
David C. Shepherd ◽  
Robert Goldstein ◽  
Benjamin Rosenblüt
Keyword(s):  
White Women ◽  
White Men ◽  
Sensitivity Study ◽  
Auditory Sensitivity ◽  
Race Difference ◽  
Men And Women ◽  
Auditory Thresholds ◽  
Békésy Audiometry ◽  
Method Of Adjustment ◽  
Better Than

Two separate studies investigated race and sex differences in normal auditory sensitivity. Study I measured thresholds at 500, 1000, and 2000 cps of 23 white men, 26 white women, 21 negro men, and 24 negro women using the method of limits. In Study II thresholds of 10 white men, 10 white women, 10 negro men, and 10 negro women were measured at 1000 cps using four different stimulus conditions and the method of adjustment by means of Bekesy audiometry. Results indicated that the white men and women in Study I heard significantly better than their negro counterparts at 1000 and 2000 cps. There were no significant differences between the average thresholds measured at 1000 cps of the white and negro men in Study II. White women produced better auditory thresholds with three stimulus conditions and significantly more sensitive thresholds with the slow pulsed stimulus than did the negro women in Study II.

scholarly journals Management of acute ischemic stroke in patients with COVID-19 infection: Report of an international panel

2020 ◽  
Vol 15 (5) ◽  
pp. 540-554 ◽  
Author(s):  
Adnan I Qureshi ◽  
Foad Abd-Allah ◽  
Fahmi Al-Senani ◽  
Emrah Aytac ◽  
Afshin Borhani-Haghighi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Current Knowledge ◽  
Intravenous Thrombolysis ◽  
Adult Patients ◽  
World Health ◽  
Stroke Patients ◽  
International Panel ◽  
Health Organization ◽  
Tract Infections

Background and purpose On 11 March 2020, World Health Organization (WHO) declared the COVID-19 infection a pandemic. The risk of ischemic stroke may be higher in patients with COVID-19 infection similar to those with other respiratory tract infections. We present a comprehensive set of practice implications in a single document for clinicians caring for adult patients with acute ischemic stroke with confirmed or suspected COVID-19 infection. Methods The practice implications were prepared after review of data to reach the consensus among stroke experts from 18 countries. The writers used systematic literature reviews, reference to previously published stroke guidelines, personal files, and expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulate practice implications. All members of the writing group had opportunities to comment in writing on the practice implications and approved the final version of this document. Results This document with consensus is divided into 18 sections. A total of 41 conclusions and practice implications have been developed. The document includes practice implications for evaluation of stroke patients with caution for stroke team members to avoid COVID-19 exposure, during clinical evaluation and performance of imaging and laboratory procedures with special considerations of intravenous thrombolysis and mechanical thrombectomy in stroke patients with suspected or confirmed COVID-19 infection. Conclusions These practice implications with consensus based on the currently available evidence aim to guide clinicians caring for adult patients with acute ischemic stroke who are suspected of, or confirmed, with COVID-19 infection. Under certain circumstances, however, only limited evidence is available to support these practice implications, suggesting an urgent need for establishing procedures for the management of stroke patients with suspected or confirmed COVID-19 infection.

scholarly journals Acute reperfusion therapies for acute ischemic stroke patients with unknown time of symptom onset or in extended time windows: an individualized approach

2021 ◽  
Vol 14 ◽  
pp. 175628642110211
Author(s):  
Georgios Magoufis ◽  
Apostolos Safouris ◽  
Guy Raphaeli ◽  
Odysseas Kargiotis ◽  
Klearchos Psychogios ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Time Windows ◽  
Intravenous Thrombolysis ◽  
Inclusion Criteria ◽  
Stroke Patients ◽  
Treatment Algorithms ◽  
Late Presenters

Recent randomized controlled clinical trials (RCTs) have revolutionized acute ischemic stroke care by extending the use of intravenous thrombolysis and endovascular reperfusion therapies in time windows that have been originally considered futile or even unsafe. Both systemic and endovascular reperfusion therapies have been shown to improve outcome in patients with wake-up strokes or symptom onset beyond 4.5 h for intravenous thrombolysis and beyond 6 h for endovascular treatment; however, they require advanced neuroimaging to select stroke patients safely. Experts have proposed simpler imaging algorithms but high-quality data on safety and efficacy are currently missing. RCTs used diverse imaging and clinical inclusion criteria for patient selection during the dawn of this novel stroke treatment paradigm. After taking into consideration the dismal prognosis of nonrecanalized ischemic stroke patients and the substantial clinical benefit of reperfusion therapies in selected late presenters, we propose rescue reperfusion therapies for acute ischemic stroke patients not fulfilling all clinical and imaging inclusion criteria as an option in a subgroup of patients with clinical and radiological profiles suggesting low risk for complications, notably hemorrhagic transformation as well as local or remote parenchymal hemorrhage. Incorporating new data to treatment algorithms may seem perplexing to stroke physicians, since treatment and imaging capabilities of each stroke center may dictate diverse treatment pathways. This narrative review will summarize current data that will assist clinicians in the selection of those late presenters that will most likely benefit from acute reperfusion therapies. Different treatment algorithms are provided according to available neuroimaging and endovascular treatment capabilities.

scholarly journals Incorporation of α2-Plasmin Inhibitor into Fibrin Clots and Its Association with the Clinical Outcome of Acute Ischemic Stroke Patients

Biomolecules ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 347
Author(s):  
Zsuzsa Bagoly ◽  
Barbara Baráth ◽  
Rita Orbán-Kálmándi ◽  
István Szegedi ◽  
Réka Bogáti ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Intravenous Thrombolysis ◽  
Fibrin Clot ◽  
Clot Lysis ◽  
Stroke Patients ◽  
Plasmin Inhibitor ◽  
Fibrin Clots

Cross-linking of α2-plasmin inhibitor (α2-PI) to fibrin by activated factor XIII (FXIIIa) is essential for the inhibition of fibrinolysis. Little is known about the factors modifying α2-PI incorporation into the fibrin clot and whether the extent of incorporation has clinical consequences. Herein we calculated the extent of α2-PI incorporation by measuring α2-PI antigen levels from plasma and serum obtained after clotting the plasma by thrombin and Ca2+. The modifying effect of FXIII was studied by spiking of FXIII-A-deficient plasma with purified plasma FXIII. Fibrinogen, FXIII, α2-PI incorporation, in vitro clot-lysis, soluble fibroblast activation protein and α2-PI p.Arg6Trp polymorphism were measured from samples of 57 acute ischemic stroke patients obtained before thrombolysis and of 26 healthy controls. Increasing FXIII levels even at levels above the upper limit of normal increased α2-PI incorporation into the fibrin clot. α2-PI incorporation of controls and patients with good outcomes did not differ significantly (49.4 ± 4.6% vs. 47.4 ± 6.7%, p = 1.000), however it was significantly lower in patients suffering post-lysis intracranial hemorrhage (37.3 ± 14.0%, p = 0.004). In conclusion, increased FXIII levels resulted in elevated incorporation of α2-PI into fibrin clots. In stroke patients undergoing intravenous thrombolysis treatment, α2-PI incorporation shows an association with the outcome of therapy, particularly with thrombolysis-associated intracranial hemorrhage.

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