The primary purposes of this study were to identify factors associated with use of thrombolytic therapy in a community setting, particularly among Mexican-Americans, and to examine the effect of thrombolytic therapy on both short and long term survival in an attempt to determine whether or not the survival benefits reported from clinical trials have been realized in a community setting. The study group consisted of 1,199 patients who participated in the population-based surveillance project in Corpus Cristi/ Nueces County, Texas and were hospitalized for definite or possible myocardial infarction, angioplasty, or aortocoronary bypass surgery. The ethnic composition of the sample population was 271 Mexican-American women, 210 non-Hispanic white women, 339 Mexican-American men, and 379 non-Hispanic white men.

The investigators found that, following adjustment for potential confounding variables, “Mexican-Americans were 43% less likely to receive to receive thrombolysis than non-Hispanic whites, and women were 43% less likely to receive thrombolysis than men. Neither age, nor any of the medical history variables, with the exception of history of stroke, was associated with receipt of thrombolysis.” To further investigate the “apparent ethnicity- and sex-related bias,” the investigators examined a “subgroup of 211 patients without a history of stroke” and found that among these “ideal candidates” women were 39% less likely than men and Mexican-Americans were 34% less likely than non-Hispanic whites to receive thrombolytic therapy.”

One potential explanation for these disparities is that “women and Mexican-Americans hospitalized for myocardial infarction met criteria for use of thrombolysis less frequently than men and non-Hispanic whites.” However, as the authors note, “even after restriction of the analysis to a subgroup of ‘ideal’ candidates for thrombolysis, women and Mexican-Americans were found to receive thrombolysis less frequently than men and non-Hispanic whites.”

In sum, despite the finding that there is “a 41% reduction in long-term mortality associated with the receipt of thrombolytic therapy” and the evidence that “physicians were generally following recommendations regarding the use of thrombolysis,” women and Mexican-Americans “were less likely to receive thrombolytic therapy than men and non-Hispanic whites.”