title: Racial-Ethnic Disparities in Acute Stroke Care in the Florida-Puerto Rico Collaboration to Reduce Stroke Disparities Study.
abstract: Racial-ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race-ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines-Stroke hospitals.
  
  
  
  Seventy-five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010-2014). Logistic regression models examined racial-ethnic differences in acute stroke performance measures and defect-free care (intravenous tissue plasminogen activator treatment, in-hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, smoking cessation counseling) and temporal trends. Among ischemic stroke cases, 63% were non-Hispanic white (NHW), 18% were non-Hispanic black (NHB), 14% were Hispanic living in Florida, and 6% were Hispanic living in Puerto Rico. NHW patients were the oldest, followed by Hispanics, and NHBs. Defect-free care was greatest among NHBs (81%), followed by NHWs (79%) and Florida Hispanics (79%), then Puerto Rico Hispanics (57%) (P<0.0001). Puerto Rico Hispanics were less likely than Florida whites to meet any stroke care performance metric other than anticoagulation. Defect-free care improved for all groups during 2010-2014, but the disparity in Puerto Rico persisted (2010: NHWs=63%, NHBs=65%, Florida Hispanics=59%, Puerto Rico Hispanics=31%; 2014: NHWs=93%, NHBs=94%, Florida Hispanics=94%, Puerto Rico Hispanics=63%).
  
  
  
  Racial-ethnic/geographic disparities were observed for acute stroke care performance metrics. Adoption of a quality improvement program improved stroke care from 2010 to 2014 in Puerto Rico and all Florida racial-ethnic groups. However, stroke care quality delivered in Puerto Rico is lower than in Florida. Sustained support of evidence-based acute stroke quality improvement programs is required to improve stroke care and minimize racial-ethnic disparities, particularly in resource-strained Puerto Rico.
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL rsacco@med.miami.edu.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Hannah
authors.initials: H
authors.lastname: Gardener
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Kefeng
authors.initials: K
authors.lastname: Wang
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Chuanhui
authors.initials: C
authors.lastname: Dong
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Ciliberti-Vargas
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Carolina M
authors.initials: CM
authors.lastname: Gutierrez
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Negar
authors.initials: N
authors.lastname: Asdaghi
authors.affiliation: University of South Florida Morsani College of Medicine, Tampa, FL.
authors.forename: W Scott
authors.initials: WS
authors.lastname: Burgin
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Olveen
authors.initials: O
authors.lastname: Carrasquillo
authors.affiliation: University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
authors.forename: Enid J
authors.initials: EJ
authors.lastname: Garcia-Rivera
authors.affiliation: Hospital HIMA San Pablo, Caguas, Puerto Rico.
authors.forename: Ulises
authors.initials: U
authors.lastname: Nobo
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Sofia
authors.initials: S
authors.lastname: Oluwole
authors.affiliation: University of South Florida Morsani College of Medicine, Tampa, FL.
authors.forename: David Z
authors.initials: DZ
authors.lastname: Rose
authors.affiliation: Barrow Neurological Institute, Phoenix, AZ.
authors.forename: Michael F
authors.initials: MF
authors.lastname: Waters
authors.affiliation: Florida International University Herbert Wertheim College of Medicine, Miami, FL.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Zevallos
authors.affiliation: American Heart Association, Marietta, GA.
authors.forename: Mary
authors.initials: M
authors.lastname: Robichaux
authors.affiliation: National Institute of Neurological Disorders and Stroke, Bethesda, MD.
authors.forename: Salina P
authors.initials: SP
authors.lastname: Waddy
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Jose G
authors.initials: JG
authors.lastname: Romano
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
mesh_terms: D000208:Acute Disease; D000368:Aged; D002545:Brain Ischemia / Q000208:ethnology* / Q000517:prevention & control; D005006:Ethnicity; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D011379:Prognosis; D011647:Puerto Rico / Q000453:epidemiology; D044469:Racial Groups; D012042:Registries; D012189:Retrospective Studies; D012959:Socioeconomic Factors
keywords: cerebrovascular disease; disparities; ethnicity; race