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Are there disparities in acute stroke treatment between the Jewish and Arab populations in Israel? Results from the National Acute Stroke Israeli registry

Published:February 19, 2021DOI:https://doi.org/10.1016/j.jns.2021.117357

      Highlights

      • NASIS-REVASC was a prospective registry of patients treated with systemic tPA (IVT) and/or thrombectomy (EVT) in Israel.
      • Among 1,432 patients included in NASIS-REVASC, 143 (10%) were of Arab ethnicity.
      • Arab patients were younger, had higher rates of smoking and diabetes and were less frequently treated with tPA.
      • The rates of any intervention with either IVT or EVT and rates of favorable outcomes and mortality were comparable.
      • These findings indicate lack of disparity in stroke care among patients treated acutely with IVT and/or EVT in Israel.

      Abstract

      Background

      According to the latest reported data from the National Acute Stroke Israeli Survey (NASIS), around 18,000 strokes occur annually in Israel. Data regarding disparities in stroke care between the Jewish and the Arab populations in Israel are lacking.

      Aims

      We wished to compare demographics, comorbidities, stroke characteristics and outcomes between Jewish and Arab stroke patients in Israel that were acutely treated with intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT), in order to test if there are disparities or any ethnic-specific parameters.

      Methods

      The National Acute Stroke Israeli registry of patients undergoing revascularization (NASIS-REVASC) prospectively enrolled patients in six comprehensive stroke centers between 1/2014 and 3/2016. In this observational research, we compared demographics, comorbidities, time metrics, stroke characteristics and outcomes between Jewish and Arab patients enrolled.

      Results

      NASIS-REVASC included 1432 patients out of which 143 (10%) were of Arab ethnicity and 1289 (90%) of Jewish ethnicity. Arab patients were significantly younger (66 ± 14 vs. 73 ± 29, p = 0·004), exhibited higher rates of smoking and diabetes (31% vs. 18% and 57% vs. 34%, p < 0·001 for both), and were less often treated with systemic thrombolysis (48% vs. 59%, p = 0·012). However, the rates of any interventional treatment with either intravenous thrombolysis or endovascular thrombectomy as well as the rates of favorable outcomes and mortality were comparable between groups.

      Conclusions

      Despite several baseline differences between Arab and Jewish Israeli stroke patients, treatment allocations, survival and functional outcomes were similar indicating lack of disparity in stroke care among patients treated acutely with IVT and/or EVT in Israel.

      Data access statement

      Full data is available following a formal request to the NASIS-REVASC registry at the Israeli Health Ministry.

      Keywords

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