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

Abstract

ObjectiveTo 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.MethodsWe 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.ResultsSES 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).ConclusionsLonger driving times were associated with lower odds of tPA administration and longer OTA; however, SES did not modify these associations.

Effect of Transport Time on the Use of Reperfusion Therapy for Patients with Acute Ischemic Stroke in Korea

“…However, a recent large study enrolling 118,683 patients from the Get With The Guidelines-Stroke Registry (GWTG-Stroke) in the US found a significant association between a longer driving time to hospital and longer onset to arrival time and lower odds of IVT. 10 In our study, the proportion of patients treated with IVT decreased significantly when patients had more than 90 minutes of the ground transport time from the hospital. Our findings suggest that the distance to the hospital will not be a major barrier to the use of IVT in South Korea as more than 98% of the South Korean population lives within 90 min from 67 accredited stroke centers in this study.…”

“… 5 6 Several previous studies have suggested the probability of receiving reperfusion therapies for acute ischemic stroke increased when the patients lived in close geographic proximity to hospitals that provide the therapy, however other studies did not find a significant association between the transport time from home to hospital and the use of reperfusion therapy. 7 8 9 10 For example, longer driving time to the treating hospital was significantly associated with longer onset-to-arrival time to the hospitals and lower odds of receiving intravenous thrombolysis (IVT) in a retrospective study of 118,683 acute stroke patients admitted to 1,489 US hospitals. 10 For endovascular therapy (EVT) for acute ischemic stroke, the proportion of stroke patients receiving EVT decreased significantly when patients lived beyond a 1-hour ground transport time from hospitals that offer EVT in California during 2009 and 2010.…”

“… 7 8 9 10 For example, longer driving time to the treating hospital was significantly associated with longer onset-to-arrival time to the hospitals and lower odds of receiving intravenous thrombolysis (IVT) in a retrospective study of 118,683 acute stroke patients admitted to 1,489 US hospitals. 10 For endovascular therapy (EVT) for acute ischemic stroke, the proportion of stroke patients receiving EVT decreased significantly when patients lived beyond a 1-hour ground transport time from hospitals that offer EVT in California during 2009 and 2010. 7 …”

GRP per capita and hospital characteristics associated with intravenous tissue plasminogen activator adherence rate: evidence from the Chinese Stroke Center Alliance

“…Ader et al observed that SES wasn't associated with tPA administration among patients in the USA. 20 It remains unclear how socioeconomic factors are associated with adherence rate of IV-rt PA. To the best of our knowledge, there are no published empirical studies that explore how macroeconomics and hospital-level factors associate with the adherence rate to IV-rt PA in China.…”

Risk and space: modelling the accessibility of stroke centers using day- & nighttime population distribution and different transportation scenarios

“…Another important aspect for the care of acute stroke patients and of Emergency Medical Services (EMS) in general is the organization of medical first aid. There is a correlation between stroke-related mortality and travel time to the nearest stroke unit [ 1 , 9 , 10 ]. In a key issues paper on emergency medical care in the prehospital and clinical phase, (Fischer et al [ 20 ]: 393) make the following recommendations for stroke care: “ A prehospital time of maximum 60 min to transfer the patient to the nearest suitable hospital with a certified stroke unit is acceptable”.…”