Study finds more stroke imaging for African-Americans, men and younger patients than for other subpopulations

Patients presenting with stroke symptoms have a better chance of receiving advanced neuroimaging if they are male, under 55 or African-American than do patients in none of those demographics, according to a study presented May 25 at the American Society of Neuroradiology’s annual meeting in Washington, D.C.

Achala Vagal, MD, of the University of Cincinnati, and team further found that the odds of receiving advanced neuroimaging—in the form of head CT without contrast, head MRI, CT angiogram, MR angiogram or carotid ultrasound—rose for patients first seen in an academic medical setting versus a community hospital.

“Rates of diagnostic workup in stroke have increased over time; however, less is known about differences in utilization of neuroimaging for stroke from a population perspective,” Vagal said in a news release sent by the University of Cincinnati Academic Health Center. “In this study, we found that age, sex and race do matter as far as neuroimaging use is concerned.”

The team analyzed data from the NIH-funded Greater Cincinnati/Northern Kentucky Stroke Study, which incorporates records from hospitals, clinics, coroners’ offices, nursing homes and physician offices in a five-county region “that is representative of the United States for age, percentage of African-American residents, median income and educational level,” the release states.

Patient charts and imaging records from stroke patients in calendar years 2005 and 2010 were pulled by research nurses and reviewed by study physicians. The researchers calculated the proportion of imaging use within two days of stroke occurrence or hospital admission date.

The data reflected 3,226 patients with 3,471 stroke or mini-stroke (transient ischemic attack) events in 2005 and 3,213 patients with 3,431 events in 2010.  

Vagal and colleagues found that a higher proportion of African-Americans than Caucasians received head CT without contrast (96 percent vs. 92 percent), MRI (59 percent vs. 51 percent) and MR angiogram (41 percent vs. 31 percent), although there was no racial difference in the other imaging modalities.

Additionally, a higher proportion of males received MRI (55 percent vs. 51 percent) and MR angiogram (36 percent vs. 31 percent) as compared to females in both 2005 and 2010, with no gender differences in use of the other imaging modalities.

Meanwhile all imaging use except CT without contrast and carotid ultrasound was higher in patients under 55 as compared to older patients.

The overall odds of receiving a head CT scan without contrast did not differ significantly by age, sex and race.

“The differences discovered in this study may be partly driven by age, with younger patients getting more extensive workups and partly by access to stroke expertise,” Vagal said. “However, further understanding of the contributors can provide an important basis for newer lines of inquiry into environmental, socioeconomic and access to healthcare issues.”