scholarly journals Lower carotid revascularization rates after stroke in racial/ethnic minority-serving US hospitals

Neurology ◽  
2019 ◽  
Vol 92 (23) ◽  
pp. e2653-e2660 ◽  
Author(s):  
Roland Faigle ◽  
Lisa A. Cooper ◽  
Rebecca F. Gottesman
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Predominantly White ◽  
Ethnic Minority ◽  
System Level ◽  
Carotid Revascularization ◽  
Logistic Regression Models ◽  
Race Disparities ◽  
Revascularization Procedures ◽  
Racial Ethnic

ObjectiveWe sought to determine whether the use of carotid revascularization procedures after stroke due to carotid stenosis differs between minority-serving hospitals and hospitals serving predominantly white patients.MethodsWe identified ischemic stroke cases due to carotid disease, identified by ICD-9-CM codes, from 2007 to 2011 in the Nationwide Inpatient Sample. The use of carotid endarterectomy (CEA) and carotid artery stenting (CAS) was recorded. Hospitals with ≥40% racial/ethnic minority patients (minority-serving hospitals) were compared to hospitals with <40% minority patients (predominantly white hospitals [hereafter, abbreviated to white]). Logistic regression was used to evaluate the use of CEA/CAS among minority-serving and white hospitals.ResultsOf the 26,189 ischemic stroke cases meeting inclusion criteria, 20,870 (79.7%) were treated at 1,113 white hospitals and 5,319 (20.3%) received care at 325 minority-serving hospitals. Compared to patients in white hospitals, patients in minority-serving hospitals were less likely to undergo CEA/CAS (17.6%, 95% confidence interval [CI] 16.6%–18.6%, in minority-serving vs 21.2%, 95% CI 20.7%–21.8%, in white hospitals; p < 0.001). In fully adjusted logistic regression models, the odds of CEA/CAS were lower in minority-serving compared to white hospitals (odds ratio 0.81, 95% CI 0.70–0.93), independent of individual patient race/ethnicity and other measured hospital characteristics. White and Hispanic individuals had significantly lower odds of CEA/CAS in minority-serving compared to white hospitals. Patient-level racial/ethnic differences in the use of carotid revascularization procedures remained within each hospital stratum.ConclusionThe odds of carotid revascularization after stroke is lower in minority- compared to white-serving hospitals, suggesting system-level factors as a major contributor to explain race disparities in the use of carotid revascularization.

Abstract W P304: Variation in Use of Carotid Revascularization Procedures and In-Hospital Mortality Among Large, Urban Teaching Hospitals in the United States

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Judith H Lichtman ◽  
Erica C Leifheit-Limson ◽  
Yun Wang ◽  
Virginia J Howard ◽  
Larry B Goldstein
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
The United States ◽  
System Level ◽  
Teaching Hospitals ◽  
Future Research ◽  
Urban Teaching ◽  
Carotid Revascularization ◽  
Hospital Variation ◽  
Revascularization Procedures

Background: Guidelines and quality improvement efforts seek to minimize variation in care and outcomes across hospitals. We assessed hospital-level variation in procedure rates and in-hospital mortality for patients hospitalized with ischemic stroke at similar hospitals in the US. The use of procedures and in-hospital mortality were not expected to vary significantly among comparable, high-volume facilities after adjusting for patient case-mix. Methods: We selected urban teaching hospitals with ≥100 annual ischemic stroke discharges (ICD-9 433, 434, 436) from the Nationwide Inpatient Sample 2010-2011. Generalized linear mixed models were used to quantify between-hospital variation in the use of carotid artery stenting (CAS) and endarterectomy (CEA), as well as in-hospital mortality, adjusting for patient characteristics. Adjusted odds ratios were calculated to reflect the odds that patients would have the procedure/outcome when treated at hospitals 1 SD above relative to hospitals 1 SD below the overall rate for that procedure/outcome (an odds ratio of 1.0 would reflect no hospital variation in the procedure/outcome). Results: A total of 105 urban teaching hospitals were selected, with a median annual volume of 453 ischemic stroke discharges (IQR 351-600). Among a total of 52,090 ischemic stroke discharges (mean age 68±14.8 yrs), the overall rates were 3.7% (SD 3.1) for CAS and 15.6% (SD 8.0) for CEA; in-hospital mortality was 4.3% (SD 1.7). The odds of receiving CAS and CEA were almost 7 and 4 times as high, respectively, for a patient treated at a hospital 1 SD above versus 1 SD below the overall rate for that procedure (CAS: 6.68, 95% CI 4.97-8.98; CEA: 3.62, 95% CI 3.17-4.13). The odds of dying for those treated at a hospital 1 SD above relative to 1 SD below the overall mortality rate were 2.09 (95% CI 1.98-2.21). Conclusions: There was marked between-hospital heterogeneity in the use of carotid revascularization procedures and in-hospital mortality among large, urban US teaching hospitals. Future research needs to identify system-level factors contributing to these variations in care and outcomes.

scholarly journals POS0023 RACIAL/ETHNIC AND REGIONAL DIFFERENCES IN MULTIMORBIDITY BETWEEN PATIENTS WITH RHEUMATOID ARTHRITIS AND COMPARATORS IN A LARGE NATIONWIDE US STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 213.1-214
Author(s):  
H. J. Dykhoff ◽  
E. Myasoedova ◽  
M. Peterson ◽  
J. M. Davis ◽  
V. Kronzer ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Logistic Regression ◽  
Regression Models ◽  
Index Date ◽  
Ethnic Disparities ◽  
Logistic Regression Models ◽  
The Us ◽  
Race Ethnicity ◽  
Geographic Regions ◽  
Racial Ethnic

Background:Patients with rheumatoid arthritis (RA) have an increased burden of multimorbidity. Racial/ethnic disparities have also been associated with an increased burden of multimorbidity.Objectives:We aimed to compare multimorbidity among different racial/ethnic groups and geographic regions of the US in patients with RA and comparators without RA.Methods:We used a large longitudinal, real-world data warehouse with de-identified administrative claims for commercial and Medicare Advantage enrollees, to identify cases of RA and matched controls. Cases were defined as patients aged ≥18 years with ≥2 diagnoses of RA in January 1, 2010 - June 30, 2019 and ≥1 prescription fill for methotrexate in the year after the first RA diagnosis. Controls were persons without RA matched 1:1 to RA cases on age, sex, census region, calendar year of index date (corresponding to the date of second diagnosis code for RA), and length of prior medical/pharmacy coverage. Race was classified as non-Hispanic White (White), non-Hispanic Black (Black), Asian, Hispanic, or other/unknown, based on self-report or derived rule sets. Multimorbidity (2 or more comorbidities) was defined using 25 chronic comorbidities from a combination of the Charlson and Elixhauser Comorbidity Indices assessed during the year prior to index date. Rheumatic comorbidities were not included. Logistic regression models were used to estimate odds ratios (OR) with 95% confidence intervals (CI).Results:The study included 16,363 cases with RA and 16,363 matched non-RA comparators (mean age 58.2 years, 70.7% female for both cohorts). Geographic regions were the same in both cohorts: 50% South, 26% Midwest, 13% West, and 11% Northeast. Race/ethnicity was not part of the matching criteria and varied slightly between the cohorts: among RA (non-RA) patients, 74% (74%) were White, 11% (9%) Hispanic, 10% (9%) Black, 3% (4%) Asian, and 3% (4%) other/unknown. Patients with RA had more multimorbidity than non-RA subjects (51.3% vs 44.8%). Multimorbidity comparisons across US geographic regions were similar in both cohorts, with comparable multimorbidity levels for patients in the West and Midwest and higher levels for those in the Northeast and South (Figure 1). Among the non-RA patients, 43.5% of Whites experienced multimorbidity, compared to 33.9% of Asians, 46.1% of Hispanics, and 58.4% of Blacks. These associations remained after adjustment for age, sex, and geographic region, with significantly lower multimorbidity among Asians (OR: 0.81; 95%CI: 0.67-0.99) and significantly higher multimorbidity among Hispanics (OR: 1.21; 95%CI: 1.07-1.37) and Blacks (OR: 1.74; 95%CI: 1.54-1.97), compared to Whites in the non-RA cohort. Among the RA patients, racial/ethnic differences were less pronounced; 50.6% of Whites, 42.8% of Asians, 48.8% of Hispanics, and 58.4% of Blacks experienced multimorbidity. Adjusted analyses revealed no significant differences in multimorbidity for Asians (OR: 0.88; 95%CI: 0.70-1.08) and Hispanics (OR: 1.06; 95%CI: 0.95-1.19) and a less pronounced increase in multimorbidity among Blacks (OR: 1.32; 95%CI: 1.17-1.49) compared to Whites in the RA cohort.Conclusion:This large nationwide study showed increased occurrence of multimorbidity in RA versus non-RA patients and in both cohorts for residents of the Northeast and South regions of the US. Racial/ethnic disparities in multimorbidity were more pronounced among patients without RA compared to RA patients. This indicates the effects of RA and race/ethnicity on multimorbidity do not aggregate. The underlying mechanisms for these associations require further investigation.Figure 1.Logistic regression models comparing multimorbidity levels in RA and non-RA cohorts.Disclosure of Interests:Hayley J. Dykhoff: None declared, Elena Myasoedova: None declared, Madeline Peterson: None declared, John M Davis III Grant/research support from: Research grant from Pfizer, Vanessa Kronzer: None declared, Caitrin Coffey: None declared, Tina Gunderson: None declared, Cynthia S. Crowson: None declared.

Abstract 1911: Recanalization of Proximal Arterial Occlusion in the SENTIS Trial

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
David S Liebeskind ◽  
Ashfaq Shuaib ◽  
Martin Köhrmann ◽  
William P Dillon ◽  
Songling Liu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Medical History ◽  
Controlled Trial ◽  
Arterial Occlusion ◽  
Stroke Severity ◽  
Nihss Score ◽  
Logistic Regression Models ◽  
Multivariable Logistic Regression

Background: Collateral circulation may enhance recanalization in acute ischemic stroke. Augmentation of collaterals with partial aortic occlusion may promote recanalization and thereby influence outcomes in the SENTIS randomized controlled trial of the NeuroFlo device. We conducted a post hoc analysis of angiography acquired in SENTIS to evaluate potential differences in recanalization rates between NeuroFlo-treated and non-treated arms, accounting for site of arterial occlusion. Methods: Blinded imaging expert review of baseline and 6-hour follow-up angiography (CTA, MRA, or DSA) from the core lab was conducted for evaluation of recanalization. Recanalization was defined as TIMI 2-3 in the arterial segment distal to baseline occlusion. Baseline demographics, stroke presentation characteristics, and medical history variables were analyzed with respect to recanalization in univariate and subsequent multivariable logistic regression models after adjusting by treatment arm. Results: Serial angiography was available in 109/515 SENTIS subjects, including 56 in the treatment arm and 53 in the non-treated arm. Baseline demographics, stroke presentation characteristics, and medical history variables did not differ statistically between arms. Across all sites of arterial occlusion, recanalization occurred in 25.7% of cases, with similar rates between device (25.0%) and medical therapy (26.4%) arms. Age and baseline stroke severity (NIHSS score) were significant predictors of recanalization in univariate analyses. Multivariable logistic regression analyses confirmed that baseline NIHSS score was the sole predictor of recanalization (OR 0.90, p=0.0458) per one unit increase, with decreased recanalization in more severe strokes. Device treatment was not associated with significant increases in recanalization rates (p=NS). Recanalization of terminal internal carotid artery (12.5%), proximal MCA or M1 (17.9%) and M2 (46.7%) occlusions was not different between arms (all p=NS). Recanalization of proximal arterial occlusion in acute ischemic stroke cases enrolled in SENTIS was more frequent in M2 occlusions. Conclusions: More severe strokes at baseline were less likely to recanalize and device therapy did not increase recanalization rates. Treatment with the NeuroFlo device may invoke mechanisms of collateral perfusion distinct from direct arterial recanalization.

scholarly journals Timing of Carotid Revascularization Procedures After Ischemic Stroke

Stroke ◽  
2017 ◽  
Vol 48 (1) ◽  
pp. 225-228 ◽  
Author(s):  
Michael Reznik ◽  
Hooman Kamel ◽  
Gino Gialdini ◽  
Ankur Pandya ◽  
Babak B. Navi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Revascularization ◽  
Revascularization Procedures

Racial, ethnic differences in complementary and integrative health use among adults with mental illness: Results from the 2017 National Health Interview Survey

2021 ◽  
pp. 1-24
Author(s):  
Lee Za Ong ◽  
Karisse A. Callender ◽  
Kacie M. Blalock ◽  
Jerome J. Holzbauer
Keyword(s):  
Mental Illness ◽  
Logistic Regression ◽  
Ethnic Minority ◽  
National Health ◽  
National Health Interview Survey ◽  
Black African ◽  
Health Interview Survey ◽  
Integrative Health ◽  
Interview Survey ◽  
Racial Ethnic

Abstract The purpose of this study was to examine the patterns of complementary and integrative health (CIH) use among adults with a racial/ethnic minority background and a mental illness. A secondary data analysis of 2017 National Health Interview Survey (N = 793) was conducted using chi-square, multivariate logistic regression, and multinomial logistic regression. Overall, Black/African Americans and Hispanic/Latinx groups remained the least proportional of CIH therapies utilization. Being a male, Black/African American or Latinx/Hispanic and had work experience were predictors of the least use of the CIH therapies. Research is needed to bridge the gaps on the CIH use among a racial/ethnic minority with mental illness and to enhance the equitable and collaborative mental health care in the community.

Workforce Diversity and Job Satisfaction of the Majority and the Minority

2016 ◽  
Vol 37 (1) ◽  
pp. 84-107 ◽  
Author(s):  
Sungjoo Choi
Keyword(s):  
Job Satisfaction ◽  
Predominantly White ◽  
Ethnic Minority ◽  
Ethnic Minorities ◽  
Fixed Effects ◽  
Ordinary Least Squares ◽  
Workforce Diversity ◽  
Racial Mixture ◽  
Federal Workforce ◽  
Racial Ethnic

The structural approaches of workforce diversity note that the racial composition of work groups may affect work attitudes of racial/ethnic minority and White employees in different ways. Analyzing the data from the federal workforce, this study examines how the racial mixture of the agency affects job satisfaction of racial/ethnic minority and White employees. To do so, three models for all employees, Whites, and racial/ethnic minorities were tested using ordinary least squares (OLS) regressions with agency-fixed effects. The results suggest that holding a minority status in their agency may bring lower job satisfaction to both racial/ethnic minority and White employees. Racial/ethnic minorities reported the lowest job satisfaction in predominantly White settings, while Whites expressed the lowest job satisfaction in minority–majority settings. In contrast, racial/ethnic minorities reported the highest job satisfaction when they hold a majority status in their agency (minority–majority settings). Interestingly, Whites seem to be most satisfied in White-majorities settings, which are less homogeneous than predominantly White settings. The finding for all employees showed that federal employees stated higher satisfaction in White-majorities settings than in others.

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