Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Ader J

PROVIDER: S-EPMC6711658 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe association between socioeconomic status (SES) and stroke risk remains controversial around the world. It is not clear that the effect of SES on stroke in China due to the lack of relevant research. We aimed to assess the association between SES and risks of first-ever ischemic stroke in Guangzhou, China.MethodsCases were recruited from neurology department in the First Affiliated Hospital of Guangdong Pharmaceutical University during September 2016-October 2017. Age- and sex-matched controls were derived from surgical departments, over the same period. SES was assessed based on education, occupation, and income. Education was divided into ?6?years, 6-9?years, 10-12?years, and?>?12?years. Family monthly income per capita was categorized into ?¥1000, ¥1001-3000, ¥3001-5000, and?>?¥5001. Occupation was stratified into manual, non-manual, no job, and retired. A multivariate logistic regression model was used to determine the association between SES and risk of ischemic stroke.ResultsIn total, 347 ischemic stroke patients and 347 controls were recruited, with mean ages of 60.54?±?13.13 and 60.56?±?13.07?years, respectively. After adjusting for confounding factors, odds ratio (OR) for 6-9?years of education was 2.63 (95% confidence interval [CI] 1.45-4.75); >?12?years, 2.18 (1.25-3.82) compared with those for <?6?years of education. ORs for the second lowest, third lowest, and highest incomes were 1.96 (1.21-3.15), 4.16 (2.39-7.22), and 2.83(1.25-6.39), respectively, compared with those for the lowest income. ORs for manual workers and non-manual workers were 1.95 (1.23-3.07) and 1.87 (1.05-3.33), compared with individuals without jobs.ConclusionsHigher SES is positively related with risks of ischemic stroke, explained by cardiovascular diseases and unhealthy lifestyles in Guangzhou, China. Thus, effective strategies such as extensive health education, promoting a healthy lifestyle, screening for risk factors to prevent stroke should be implemented to reduce ischemic stroke incidences among the high SES group.