Botulinum Toxin Underuse in Older Stroke Survivors with Spasticity: A Nationwide Population-Based Cohort Study

While botulinum toxin type A (BoNT-A) is effective for poststroke spasticity, its accessibility in older adults remains unclear. We aimed to examine the association between BoNT-A use and age among stroke survivors.

This nationwide, population-based, retrospective cohort study analyzed data from the French National Hospital Discharge Database. Stroke survivors admitted between 2014 and 2016 were followed until 2020. BoNT-A use was assessed across different age groups (18-64, 65-74, 75-84, ≥85 years). Multivariable logistic regression was performed to examine the association between BoNT-A use and age, adjusting for potential confounders, including sex, comorbidities, stroke unit hospitalization, and rehabilitation.

BoNT-A use was reported in 1,757 (2.88%), 862 (0.99%), and 183 (0.22%) of 60,928, 86,917, and 82,725 stroke survivors aged 65-74, 75-84, and ≥85 years, respectively. These rates were significantly lower than BoNT-A use in those aged <65 years (5.13%) (p < 0.001). After adjustment, the inverse relationship between age and BoNT-A use was maintained, demonstrating an age-dependent association in the 65-74, 75-84, and ≥85 age groups vs. 18-64 years. Odds ratios (ORs) (95% confidence intervals [CIs]) were 0.49 (0.47-0.53), 0.18 (0.17-0.19), and 0.05 (0.04-0.06), respectively. Stroke unit stays (OR, 1.33; 95% CI, 1.26-1.41) and neurological rehabilitation unit stays (OR, 16.69; 95% CI, 15.59-17.87) were significantly associated with a higher probability of receiving BoNT-A.

BoNT-A use is notably low in older stroke survivors, highlighting the need to enhance equitable access to BoNT-A injections for this population.