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Disparities in evaluation at certified primary stroke centers: reasons for geographic and racial differences in stroke.

TitleDisparities in evaluation at certified primary stroke centers: reasons for geographic and racial differences in stroke.
Publication TypeJournal Article
Year of Publication2013
AuthorsMullen, MT, Judd, S, Howard, VJ, Kasner, SE, Branas, CC, Albright, KC, J Rhodes, D, Kleindorfer, DO, Carr, BG
JournalStroke
Volume44
Issue7
Pagination1930-5
Date Published2013 Jul
ISSN1524-4628
KeywordsAfrican Continental Ancestry Group, Aged, Continental Population Groups, European Continental Ancestry Group, Female, Health Status Disparities, Health Surveys, Hospitals, Special, Humans, Male, Middle Aged, Prospective Studies, Southeastern United States, Stroke, United States
Abstract

BACKGROUND AND PURPOSE: Evaluation at primary stroke centers (PSCs) has the potential to improve outcomes for patients with stroke. We looked for differences in evaluation at Joint Commission certified PSCs by race, education, income, and geography (urban versus nonurban; Southeastern Stroke Belt versus non-Stroke Belt).METHODS: Community-dwelling, black and white participants from the national Reasons for Geographic And Racial Differences in Stroke (REGARDS) prospective population-based cohort were enrolled between January 2003 and October 2007. Participants were contacted at 6-month intervals for suspected stroke events. For suspected stroke events, it was determined whether the evaluating hospital was a certified PSC.RESULTS: Of 1000 suspected strokes, 204 (20.4%) strokes were evaluated at a PSC. A smaller proportion of women than men (17.8% versus 23.0%; P=0.04), those with a previous stroke (15.1% versus 21.6%; P=0.04), those living in the Stroke Belt (14.7% versus 27.3%; P<0.001), and those in a nonurban area (9.1% versus 23.1%; P<0.001) were evaluated at a PSC. There were no differences by race, education, or income. In multivariable analysis, subjects were less likely to be evaluated at a PSC if they lived in a nonurban area (odds ratio, 0.39; 95% confidence interval, 0.22-0.67) or lived in the Stroke Belt (odds ratio, 0.54; 95% confidence interval, 0.38-0.77) or had a previous stroke (odds ratio, 0.46; 95% confidence interval, 0.27-0.78).CONCLUSIONS: Disparities in evaluation by PSCs are predominately related to geographic factors but not to race, education, or low income. Despite an increased burden of cerebrovascular disease in the Stroke Belt, subjects there were less likely to be evaluated at certified hospitals.

DOI10.1161/STROKEAHA.111.000162
Alternate JournalStroke
PubMed ID23640827
PubMed Central IDPMC3747032
Grant ListR01 HS018362 / HS / AHRQ HHS / United States
P60 MD000502 / MD / NIMHD NIH HHS / United States
T32 HS013852 / HS / AHRQ HHS / United States
U01 NS041588 / NS / NINDS NIH HHS / United States
T32 HS013852-10 / HS / AHRQ HHS / United States
P60 MD000502-08S1 / MD / NIMHD NIH HHS / United States
K12 HL083772 / HL / NHLBI NIH HHS / United States