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Race and income disparity in ischemic stroke care: nationwide inpatient sample database, 2002 to 2008.
- Source :
-
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2014 Jan; Vol. 23 (1), pp. 17-24. Date of Electronic Publication: 2012 Jul 17. - Publication Year :
- 2014
-
Abstract
- Background: Health care disparities exist between demographic groups with stroke. We examined whether patients of particular ethnicity or income levels experienced reduced access to or delays in receiving stroke care.<br />Methods: We studied all admissions for ischemic stroke in the Nationwide Inpatient Sample (NIS) database between 2002 and 2008. We used statistical models to determine whether median income or race were associated with intravenous (i.v.) thrombolysis treatment, in-hospital mortality, discharge disposition, hospital charges, and LOS in high- or low-volume hospitals.<br />Results: There were a total of 477,474 patients with ischemic stroke: 10,781 (2.3%) received i.v. thrombolysis, and 380,400 (79.7%) were treated in high-volume hospitals. Race (P < .0001) and median income (P < .001) were significant predictors of receiving i.v. thrombolysis, and minorities and low-income patients were less likely to receive i.v. thrombolysis. Median income was a predictor of access to high-volume hospitals (P < .0001), with wealthier patients more likely to be treated in high-volume hospitals, which had lower mortality rates (P = .0002). Patients in high-volume hospitals were 1.84 times more likely to receive i.v. thrombolysis (P < .0001).<br />Conclusions: African Americans, Hispanics, and low median income patients are less likely to receive i.v. thrombolysis for ischemic stroke. Low median income patients are less likely to be treated at high-volume hospitals. High-volume hospitals have lower mortality rates and a higher likelihood of treating patients with i.v. thrombolysis. There is evidence for an influence of socioeconomic status and racial disparity in the treatment of ischemic stroke.<br /> (Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Brain Ischemia epidemiology
Databases, Factual
Female
Hospital Charges statistics & numerical data
Hospital Mortality
Hospitals statistics & numerical data
Humans
Inpatients
International Classification of Diseases
Length of Stay
Male
Middle Aged
Patients
Social Class
Socioeconomic Factors
Stroke epidemiology
Thrombolytic Therapy statistics & numerical data
Treatment Outcome
United States epidemiology
Brain Ischemia therapy
Healthcare Disparities statistics & numerical data
Income statistics & numerical data
Minority Groups statistics & numerical data
Stroke therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1532-8511
- Volume :
- 23
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
- Publication Type :
- Academic Journal
- Accession number :
- 22818388
- Full Text :
- https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.06.004