title: Tale of 2 Health-care Systems: Disparities in Demographic and Clinical Characteristics between 2 Ischemic Stroke Populations in Los Angeles County.
abstract: BACKGROUND
  Individuals who present to the emergency departments of safety-net systems often have poorly controlled risk factors due to lack of primary care. Little is known about potential differences in presenting characteristics, discharge medications, and discharge destinations of patients with acute ischemic stroke (AIS) who present to safety-net settings versus university medical centers (UMCs).
  
  
  METHODS
  Demographic characteristics, medical history, premorbid medication use, stroke severity, discharge medications, and discharge destination were assessed among consecutive admissions for AIS over a 2-year period at a UMC (n = 385) versus 2 university-affiliated safety-net hospitals (SNHs) (n = 346) in Los Angeles County.
  
  
  RESULTS
  Compared with patients presenting to the UMC, individuals admitted to the SNHs were younger, more frequently male, nonwhite, current smokers, hypertensive, and diabetic; they were less likely to take antithrombotics and statins before admission, and had worse serum lipid and glycemic markers (all P < .05). Patients admitted to the UMC trended toward more cardioembolic strokes and had higher stroke severity scores (P < .0001). At discharge, patients admitted to the SNHs were more likely to receive antihypertensive medications than do patients admitted to the UMC (P < .001), but there were no differences in prescription of antiplatelet medications or statins.
  
  
  CONCLUSIONS
  Individuals with AIS admitted to SNHs in Los Angeles County are younger and have poorer vascular risk factor control than their counterparts at a UMC. Discharge treatment does not vary considerably between systems. Early and more vigorous efforts at primary vascular risk reduction among patients seen at SNHs may be warranted to reduce disparities.
authors.affiliation: Department of Neurology, University of Southern California, Los Angeles, California; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California; Keck School of Medicine, University of Southern California, Los Angeles, California. Electronic address: towfighi@usc.edu.
authors.forename: Amytis
authors.initials: A
authors.lastname: Towfighi
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Erica
authors.initials: E
authors.lastname: Patel
authors.affiliation: Department of Neurology, University of Southern California, Los Angeles, California; Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California; Keck School of Medicine, University of Southern California, Los Angeles, California.
authors.forename: Nerses
authors.initials: N
authors.lastname: Sanossian
authors.affiliation: Department of Neurology, Rancho Los Amigos National Rehabilitation Center, Downey, California.
authors.forename: Natalie P
authors.initials: NP
authors.lastname: Valle
authors.affiliation: Department of Neurology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
mesh_terms: D000046:Academic Medical Centers; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D011307:Drug Prescriptions; D004632:Emergency Medical Services; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008019:Life Style; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D012307:Risk Factors; D064876:Safety-net Providers; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents
keywords: Stroke; disparities; healthcare; risk factors; safety-net