Hospital distance, socioeconomic status, and timely treatment of ischemic stroke

Objective: To determine whether lower socioeconomic status (SES) and longer home-hospital driving time are associated with reductions in tPA administration and timeliness of the treatment.
Methods:
We conducted a retrospective observational study using data from the Get With The Guidelines-Stroke Registry (GWTG-Stroke) between January 2015 to March 2017. The study included 118,683 ischemic stroke patients age ≥18 who were transported by EMS to one of 1,489 US hospitals. We defined each patient’s SES based on their zip code median household income. We calculated the driving time between each patient’s home zip code and the hospital where they were treated, using the Google Maps Directions Application Programing Interface. The primary outcomes were tPA administration and onset-to-arrival time (OTA). Outcomes were analyzed using hierarchical multivariable logistic regression models.
Results:
SES was not associated with OTA (p=0.31) or tPA administration (p=0.47), but was associated wi...