title: Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers.
abstract: BACKGROUND
  Primary stroke centers (PSCs) utilize more recombinant tissue plasminogen activator (rt-PA) than non-PSCs. The impact of PSCs on racial disparities in rt-PA use is unknown.
  
  
  RESULTS
  We used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as PSCs by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt-PA use was defined by the International Classification of Diseases, 9th Revision procedure code 99.10. Discharges (304 152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to PSCs. A higher proportion received rt-PA at PSCs than non-PSCs in all race/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all P<0.001). In a multivariable model adjusting for year, age, sex, insurance, medical comorbidities, a diagnosis-related group-based mortality risk indicator, ZIP code median income, and hospital characteristics, blacks were less likely to receive rt-PA than whites at non-PSCs (odds ratio=0.58, 95% CI 0.50 to 0.67) and PSCs (odds ratio=0.63, 95% CI 0.54 to 0.74) and Hispanics were less likely than whites to receive rt-PA at PSCs (odds ratio=0.77, 95% CI: 0.63 to 0.95). In the fully adjusted model, interaction between race and presentation to a PSC for likelihood of receiving rt-PA did not reach significance (P=0.98).
  
  
  CONCLUSIONS
  Racial disparities in intravenous rt-PA use were not reduced by presentation to PSCs. Black patients were less likely to receive thrombolytic treatment than white patients at both non-PSCs and PSCs. Hispanic patients were less likely to be seen at PSCs relative to white patients and were less likely to receive intravenous rt-PA in the fully adjusted model.
authors.affiliation: Department of Neurology, Boston University, Boston, MA (H.J.A.) Department of Neurology, University of Pennsylvania, Philadelphia, PA (H.J.A., S.E.K., M.T.M.).
authors.forename: Hugo J
authors.initials: HJ
authors.lastname: Aparicio
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA (B.G.C.).
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA (H.J.A., S.E.K., M.T.M.).
authors.forename: Scott E
authors.initials: SE
authors.lastname: Kasner
authors.affiliation: Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, PA (M.J.K.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kallan
authors.affiliation: Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education, University of Alabama at Birmingham, AL (K.C.A.) Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities/Minority Health & Health Disparities Research Center, University of Alabama at Birmingham, AL (K.C.A.) Department of Epidemiology, University of Alabama at Birmingham, AL (K.C.A.).
authors.forename: Karen C
authors.initials: KC
authors.lastname: Albright
authors.affiliation: Department of Neurology, University of Cincinnati, OH (D.O.K.).
authors.forename: Dawn O
authors.initials: DO
authors.lastname: Kleindorfer
authors.affiliation: Department of Neurology, University of Pennsylvania, Philadelphia, PA (H.J.A., S.E.K., M.T.M.) Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (M.T.M.).
authors.forename: Michael T
authors.initials: MT
authors.lastname: Mullen
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D001741:Black or African American; D000368:Aged; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006291:Health Policy; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011994:Recombinant Proteins / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: health disparities; health policy; stroke; stroke care; thrombolysis