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Use of reperfusion therapy and time delay in patients with ischaemic stroke by immigration status: A register‐based cohort study in Denmark
Author(s) -
Mkoma George F.,
Norredam Marie,
Iversen Helle K.,
Andersen Grethe,
Johnsen Søren P.
Publication year - 2022
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.15303
Subject(s) - medicine , ischaemic stroke , register (sociolinguistics) , cohort , stroke (engine) , immigration , reperfusion therapy , cohort study , cardiology , physical therapy , ischemia , mechanical engineering , philosophy , linguistics , engineering , archaeology , history
Background and purpose Reperfusion therapy is the mainstay of treatment for acute ischaemic stroke (AIS); however, little is known about the use of reperfusion therapy and time delay amongst immigrants. Methods This is a Danish nationwide register‐based cohort study of patients with AIS aged ≥18 years ( n = 49,817) recruited from 2009 to 2018. Use of reperfusion therapy (intravenous thrombolysis and/or mechanical thrombectomy) and time delay between immigrants and Danish‐born residents were compared using multivariable logistics and quantile regression. Results Overall, 10,649 (39.8%) Danish‐born residents and 452 (39.0%) immigrants with AIS were treated with reperfusion therapy in patients arriving <4.5 h following stroke onset. Compared with Danish‐born residents, immigrants had lower odds of receiving reperfusion therapy after adjustment for prehospital delay, age, sex, stroke severity, sociodemographic factors and comorbidities (adjusted odds ratio 0.67; 95% confidence interval 0.49‒0.92, p = 0.01). The lowest odds were observed amongst immigrants originating from Poland and non‐Western countries. Similarly, immigrants had a longer prehospital delay than Danish‐born residents in the fully adjusted model in patients arriving <4.5 h after stroke onset (15 min; 95% confidence interval 4‒26 min, p = 0.03). No evidence was found that system delay and clinical outcome differed between immigrants and Danish‐born residents in patients eligible for reperfusion therapy after adjustment for sociodemographic factors and comorbidities. Conclusion Immigration status was significantly associated with lower chances of receiving reperfusion therapy and there may be differences in patient delay between immigrants and Danish‐born residents in patients arriving to a stroke unit <4.5 h after stroke onset.