Interaction of Ethnicity and Arrival Method on Thrombectomy Delay: The Society of Vascular and Interventional Neurology Collaboration

Abstract

Background Compared with non‐Hispanic White patients, non‐Hispanic Black (NHB) and Hispanic populations are less likely to receive acute treatment for ischemic stroke, and when they do, it can be delayed. We evaluated the interaction between arrival method and race or ethnicity on door‐to‐arterial puncture (DTAP) time in thrombectomy. Methods We conducted a retrospective observational cohort study of consecutive adults who underwent endovascular thrombectomy from 14 US Comprehensive Stroke Centers (January 1, 2019–July 31, 2020). DTAP was assessed in a linear mixed model including an interaction term for race or ethnicity and arrival method. Results Of the 1908 included patients, 356 of whom were Hispanic, Hispanic and NHB patients experienced significant delays in DTAP compared with non‐Hispanic White patients (adjusted βHisp=0.32, 95% CI, 0.08–0.55; βNHB=0.23; 95% CI, 0.04–0.41). More severe deficits were associated with shorter DTAP (βNIHSS per point −0.03; 95% CI −0.04 to −0.03), and arrival via emergency medical services or private vehicle versus transfer were associated with longer delays (βEMS=0.57; 95% CI, 0.41–0.74; βPV=1.27; 95% CI, 0.85–1.70). There was a significant interaction between Hispanic ethnicity and emergency medical services (P=0.03) or private vehicle arrival (P=0.04) in a direction favoring shorter treatment delays. Sites that treated a minority population of Hispanic patients (<50% being Hispanic) experienced a significant delay in DTAP among Hispanic and NHB versus non‐Hispanic White (median 72 minutes [interquartile range (IQR), 49–104] versus 83 minutes [IQR, 50–119] versus 58 minutes [IQR, 27–95], P<0.01), whereas sites treating a Hispanic majority showed no difference in DTAP (P=0.39). Conclusions Endovascular therapy is delayed in Hispanic and NHB patients when compared with non‐Hispanic White patients. Although arrival by emergency medical services or private vehicle also contributed to treatment delays, Hispanic ethnicity modified this effect such that there was less delay in DTAP. This may be related to communication barriers between caregivers and health care providers when a Hispanic patient is suddenly disabled from stroke.