Disparities in evaluation at certified primary stroke centers: reasons for geographic and racial differences in stroke.

Mullen MT, Judd S, Howard VJ, Kasner SE, Branas CC, Albright KC, Rhodes JD, Kleindorfer DO, Carr BG.

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Abstract

BACKGROUND AND PURPOSE:

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="" 0.22-0.67="" 0.27-0.78="" 0.38-0.77="" 0.39="" 0.46="" 0.54="" 23.1="" 95="" a="" analysis="" and="" area="" at="" be="" belt="" by="" confidence="" differences="" education="" evaluated="" had="" if="" in="" income.="" interval="" less="" likely="" lived="" multivariable="" no="" nonurban="" odds="" or="" p="" previous="" psc.="" psc="" race="" ratio="" stroke="" subjects="" the="" there="" they="" those="" to="" versus="" were="">

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.