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Data from: Hospital distance, socioeconomic status, and timely treatment of ischemic stroke

Citation

Ader, Jeremy et al. (2019), Data from: Hospital distance, socioeconomic status, and timely treatment of ischemic stroke, Dryad, Dataset, https://doi.org/10.5061/dryad.60j13b7

Abstract

Objective: To determine whether lower socioeconomic status (SES) and longer home-hospital driving time are associated with reductions in 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 to March 2017. The study included 118,683 ischemic stroke patients age ≥18 who were transported by EMS to one of 1,489 US hospitals. We defined each patient’s SES based on their zip code median household income. We calculated the driving time between each patient’s home zip code and the hospital where they were 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 (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 versus 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.

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