Hospital distance, socioeconomic status, and timely treatment of ischemic stroke.

Ader, Jeremy

Wu, Jingjing

Fonarow, Gregg C

Smith, Eric E

Shah, Shreyansh

Xian, Ying

Bhatt, Deepak L

Schwamm, Lee H

Reeves, Mathew J

Matsouaka, Roland A

Sheth, Kevin N

2020-10-21T19:21:18Z

2020-10-21T19:21:18Z

2019-08

2020-10-21T19:21:18Z

OBJECTIVE:To determine whether lower socioeconomic status (SES) and longer home to hospital driving time are associated with reductions in tissue plasminogen activator (tPA) administration and timeliness of the treatment. METHODS:We conducted a retrospective observational study using data from the Get With The Guidelines-Stroke Registry (GWTG-Stroke) between January 2015 and March 2017. The study included 118,683 ischemic stroke patients age ≥18 who were transported by emergency medical services to one of 1,489 US hospitals. We defined each patient's SES based on zip code median household income. We calculated the driving time between each patient's home zip code and the hospital where he or she was treated using the Google Maps Directions Application Programing Interface. The primary outcomes were tPA administration and onset-to-arrival time (OTA). Outcomes were analyzed using hierarchical multivariable logistic regression models. RESULTS:SES was not associated with OTA (p = 0.31) or tPA administration (p = 0.47), but was associated with the secondary outcomes of onset-to-treatment time (OTT) (p = 0.0160) and in-hospital mortality (p = 0.0037), with higher SES associated with shorter OTT and lower in-hospital mortality. Driving time was associated with tPA administration (p < 0.001) and OTA (p < 0.0001), with lower odds of tPA (0.83, 0.79-0.88) and longer OTA (1.30, 1.24-1.35) in patients with the longest vs shortest driving time quartiles. Lower SES quintiles were associated with slightly longer driving time quartiles (p = 0.0029), but there was no interaction between the SES and driving time for either OTA (p = 0.1145) or tPA (p = 0.6103). CONCLUSIONS:Longer driving times were associated with lower odds of tPA administration and longer OTA; however, SES did not modify these associations.

WNL.0000000000007963

0028-3878

1526-632X

https://hdl.handle.net/10161/21623

eng

Ovid Technologies (Wolters Kluwer Health)

Neurology

10.1212/wnl.0000000000007963

Humans

Tissue Plasminogen Activator

Social Class

Adolescent

Adult

Aged

Aged, 80 and over

Middle Aged

Hospitals

United States

Female

Male

Stroke

Young Adult

Time-to-Treatment

Geography, Medical

Hospital distance, socioeconomic status, and timely treatment of ischemic stroke.

Journal article

Shah, Shreyansh|0000-0001-8441-6326|0000-0003-4760-5229

Xian, Ying|0000-0002-1237-1162

Matsouaka, Roland A|0000-0002-0271-5400

e747

e757

8

School of Medicine

Duke Clinical Research Institute

Neurology, Neurocritical Care

Medicine, Clinical Pharmacology

Duke

Institutes and Centers

Neurology

Clinical Science Departments

Medicine

Biostatistics & Bioinformatics

Basic Science Departments

Published

93