Age, Sex, and Racial Differences in Neuroimaging Use in Acute Stroke: A Population-Based Study

Article Figures & Data

Table 1:

Demographics and clinical characteristics overall and by study year^{^a}

	All (N = 6902)	2005 (n = 3471)	2010 (n = 3431)
Age (median) (IQR)	72 (59–81)	72 (59–81)	71 (58–82)
Race
Black	1355 (20%)	659 (19%)	696 (20%)
White	5505 (80%)	2791 (80%)	2714 (79%)
Other	42 (1%)	21 (1%)	21 (1%)
Sex, female	3906 (57%)	1968 (57%)	1938 (56%)
Percentage below poverty ≥20%	754 (11%)	399 (12%)	355 (10%)
Care center
Academic	1026 (15%)	440 (13%)	586 (17%)
Nonacademic	5876 (85%)	3031 (87%)	2845 (83%)
ED presentation	6023 (87%)	2955 (85%)	3068 (89%)
Insurance
Any	6319 (94%)	3159 (95%)	3160 (93%)
Self-pay	415 (6%)	172 (5%)	243 (7%)
NIHSS (median) (IQR)	3 (1–7)	3 (1–7)	2 (1–6)
Case type
Hemorrhagic	821 (12%)	427 (12%)	394 (11%)
Ischemic	4412 (64%)	2147 (62%)	2265 (66%)
TIA	1669 (24%)	897 (26%)	772 (22%)
Seen by stroke team or neurologist	4287 (62%)	2006 (58%)	2281 (66%)

Table 2:

Unadjusted neuroimaging use for stroke/TIA work-up by sex, age, and race for combined study periods of 2005 and 2010^{^a}

Table 3:

Multivariable model for advanced imaging (CTA/MRI/MRA) for stroke/TIA work-up in the overall group stratified by age groups

	Overall		55 yr or Younger		Older Than 55 yr
	OR (95% CI)	P Value	OR (95% CI)	P Value	OR (95% CI)	P Value
Age 55 yr or younger	1.90 (1.63–2.22)	<.01	–	–	–	–
Race, black (reference white)^{^a}	1.27 (1.08–1.49)	<.01	1.02 (0.73–1.41)	.92	1.34 (1.12–1.61)	<.01
Sex, male	1.06 (0.95–1.18)	.32	1.06 (0.81–1.39)	.69	1.06 (0.94–1.20)	.31
Academic	1.43 (1.20–1.71)	<.01	1.21 (0.85–1.72)	.29	1.51 (1.22–1.85)	<.01
High poverty	0.85 (0.69–1.03)	.10	0.71 (0.49–1.04)	.08	0.91 (0.73–1.15)	.44
ED presentation	1.95 (1.65–2.29)	<.01	2.74 (1.81–4.14)	.01	1.84 (1.54–2.19)	<.01
Insurance (any, reference self-pay)	0.91 (0.70–1.18)	.47	0.90 (0.63–1.28)	.56	0.94 (0.64–1.39)	.76
NIHSS score	0.93 (0.92–0.94)	<.01	0.93 (0.92–0.95)	<.01	0.93 (0.92–0.94)	<.01
Event type (reference TIA)
ICH/SAH	1.22 (0.99–1.50)	.07	1.98 (1.26–3.12)	<.01	1.04 (0.82–1.33)	.72
Infarct	2.51 (2.19–2.88)	<.01	2.46 (1.78–3.41)	<.01	2.50 (2.16–2.91)	<.01
Seen by stroke team or neurologist	2.33 (2.07–2.63)	<.01	3.25 (2.38–4.43)	<.01	2.22 (1.95–2.53)	<.01
Study year 2010 (reference 2005)	1.66 (1.48–1.85)	<.01	1.77 (1.35–2.33)	<.01	1.64 (1.46–1.85)	<.01

Table 4:

Multivariable model for advanced imaging (CTA/MRI/MRA) for stroke/TIA work-up stratified by care center type and age groups

	Academic Center (n = 1026)^{^a}				Nonacademic Centers (n = 5876)^{^b}
	55 yr or Younger		Older Than 55 yr		55 yr or Younger		Older Than 55 yr
	OR (95% CI)	P Value	OR (95% CI)	P Value	OR (95% CI)	P Value	OR (95% CI)	P Value
Race, black (reference white)	0.56 (0.30–1.04)	.07	1.80 (1.19–2.72)	<.01	1.25 (0.82–1.89)	.29	1.27 (1.04–1.55)	.02
Sex, male	1.00 (0.58–1.72)	.99	1.25 (0.88–1.78)	.22	1.12 (0.82–1.54)	.48	1.05 (0.92–1.20)	.46
High poverty	0.98 (0.51–1.85)	.94	0.74 (0.47–1.17)	.20	0.64 (0.40–1.03)	.07	0.98 (0.75–1.28)	.89
ED presentation	2.09 (0.89–4.91)	.09	1.79 (1.03–3.12)	.04	3.19 (1.94–5.24)	<.01	1.83 (1.52–2.20)	<.01
Insurance (any, reference self-pay)	0.77 (0.45–1.33)	.35	0.84 (0.45–1.56)	.58	0.92 (0.57–1.47)	.73	0.99 (0.61–1.60)	.95
NIHSS	0.94 (0.92–0.97)	<.01	0.94 (0.92–0.95)	<.01	0.91 (0.89–0.94)	<.01	0.93 (0.92–0.94)	<.01
Event type (reference TIA)
ICH/SAH	0.99 (0.34–2.85)	.98	1.54 (0.80–2.96)	.20	2.46 (1.40–4.34)	<.01	0.87 (0.65–1.17)	.37
Infarct	2.12 (0.93–4.88)	.08	1.85 (1.10–3.11)	.02	2.44 (1.68–3.55)	<.01	2.58 (2.20–3.01)	<.01
Seen by stroke team or neurologist	2.39 (1.02–5.56)	.04	3.02 (1.75–5.20)	<.01	3.80 (2.68–5.38)	<.01	2.21 (1.93–2.53)	<.01
Study year 2010 (reference 2005)	3.84 (2.23–6.62)	<.01	1.88 (1.31–2.68)	<.01	1.38 (1.00–1.90)	.05	1.61 (1.42–1.83)	<.01

Note:—ED indicates emergency department; ICH, intracranial hemorrhage.
↵a In the academic care center subgroup: race by age group interaction (P < .01).
↵b In the nonacademic care center subgroup: race by age group interaction (P = .58).