J Korean Med Sci.  2025 Apr;40(13):e49. 10.3346/jkms.2025.40.e49.

Association of Age, Sex and Education With Access to the Intravenous Thrombolysis for Acute Ischemic Stroke

• Ko Y
• Kim BJ
• Kim Y
• Park JM
• Kang K
• Kim JG
• Cha JK
• Park TH
• Lee K
• Lee J
• Hong KS
• Lee BC
• Yu KH
• Kim DE
• Kim JT
• Choi JC
• Kwon JH
• Kim WJ
• Yum KS
• Sohn SI
• Park H
• Lee SH
• Park KY
• Kim CK
• Heo SH
• Han MK
• Sharrief AZ
• Sheth SA
• Bae HJ
• on behalf of CRCS-K Investigators

• KMID: 2566824
• DOI: http://doi.org/10.3346/jkms.2025.40.e49

Abstract

Background
Barriers to treatment with intravenous thrombolysis (IVT) for patients with acute ischemic stroke (AIS) in South Korea remain incompletely characterized. We analyze a nationwide prospective cohort to determine patient-level features associated with delayed presentation and non-treatment of potential IVT-eligible patients.
Methods
We identified consecutive patients with AIS from 01/2011 to 08/2023 from a multicenter and prospective acute stroke registry in Korea. Patients were defined as IVT candidates if they presented within 4.5 hours from the last known well, had no lab evidence of coagulopathy, and had National Institute of Health Stroke Scale (NIHSS) ≥ 4. Multivariable generalized linear mixed regression models were used to investigate the associations between their characteristics and the IVT candidates or the use of IVT among the candidates.
Results
Among 84,103 AIS patients, 41.0% were female, with a mean age of 69 ± 13 years and presentation NIHSS of 4 [interquartile range, 1–8]. Out of these patients, 13,757 (16.4%) were eligible for IVT, of whom 8,179 (59.5%) received IVT. Female sex (adjusted risk ratio [RR], 0.90; 95% confidence interval [CI], 0.86–0.94) and lower years of education (adjusted RR, 0.90; 95% CI, 0.84–0.97 for 0–3 years, compared to ≥ 13 years) were associated with a decreased likelihood of presenting as eligible for IVT after AIS; meanwhile, young age (adjusted RR, 1.12; 95% CI, 1.01–1.24 for ≤ 44 years, compared to 75–84 years) was associated with an increased likelihood of being an IVT candidate. Among those who were eligible for IVT, only age was significantly associated with the use of IVT (adjusted RR, 1.09; 95% CI, 1.03–1.16 for age 65–74 and adjusted RR, 0.83; 95% CI, 0.76–0.90 for ≥ 85 years, respectively).
Conclusion
Most patients with AIS present outside IVT eligibility in South Korea, and only 60% of eligible patients were ultimately treated. We identified increased age, female sex and lower education as key features on which to focus interventions for improving IVT utilization.

Keyword

Disparity; Stroke; Intravenous Thrombolysis; South Korea

Figure

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  Fig. 1 Flow diagram of study inclusion/exclusion.IVT = intravenous thrombolysis.

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