title: Disparities in evaluation at certified primary stroke centers: reasons for geographic and racial differences in stroke.
abstract: OBJECTIVE
  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.
authors: Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA.michael.mullen@uphs.upenn.edu
authors: Michael T
authors: MT
authors: Mullen
authors: Suzanne
authors: S
authors: Judd
authors: Virginia J
authors: VJ
authors: Howard
authors: Scott E
authors: SE
authors: Kasner
authors: Charles C
authors: CC
authors: Branas
authors: Karen C
authors: KC
authors: Albright
authors: J David
authors: JD
authors: Rhodes
authors: Dawn O
authors: DO
authors: Kleindorfer
authors: Brendan G
authors: BG
authors: Carr
mesh_terms: D000368:Aged; D044383:Black People / Q000208:ethnology; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D044469:Racial Groups / Q000208:ethnology; D015144:Southeastern United States / Q000453:epidemiology / Q000208:ethnology; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D014481:United States / Q000453:epidemiology / Q000208:ethnology; D044465:White People / Q000208:ethnology; D001741:Black or African American
keywords: access to care; disparities; stroke; stroke centers
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