The relationship between stroke system organization and disparities in access to stroke center care in California
Abstract Background There are significant racial and ethnic disparities in receipt of reperfusion interventions for acute ischemic stroke. Our objective was to determine whether there are disparities in access to stroke center care by race or ethnicity that help explain differences in reperfusion th...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-04-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12706 |
| _version_ | 1818476216453169152 |
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| author | Kori S. Zachrison Margaret E. Samuels‐Kalow Sijia Li Zhiyu Yan Mathew J. Reeves Renee Y. Hsia Lee H. Schwamm Carlos A. Camargo Jr |
| author_facet | Kori S. Zachrison Margaret E. Samuels‐Kalow Sijia Li Zhiyu Yan Mathew J. Reeves Renee Y. Hsia Lee H. Schwamm Carlos A. Camargo Jr |
| author_sort | Kori S. Zachrison |
| collection | DOAJ |
| description | Abstract Background There are significant racial and ethnic disparities in receipt of reperfusion interventions for acute ischemic stroke. Our objective was to determine whether there are disparities in access to stroke center care by race or ethnicity that help explain differences in reperfusion therapy and to understand whether interhospital patient transfer plays a role in improving access. Methods Using statewide administrating data including all emergency department and hospital discharges in California from 2010 to 2017, we identified all acute ischemic stroke patients. Primary outcomes of interest included presentation to primary or comprehensive stroke center (PSC or CSC), interhospital transfer, discharge from PSC or CSC, and discharge from CSC alone. We used hierarchical logistic regression modeling to identify the relationship between patient‐ and hospital‐level characteristics and outcomes of interest. Results Of 336,247 ischemic stroke patients, 55.4% were non‐Hispanic White, 19.6% Hispanic, 10.6% non‐Hispanic Asian/Pacific Islander, and 10.3% non‐Hispanic Black. There was no difference in initial presentation to stroke center hospitals between groups. However, adjusted odds of reperfusion intervention, interhospital transfer and discharge from CSC did vary by race and ethnicity. Adjusted odds of interhospital transfer were lower among Hispanic (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.89 to 0.98) and non‐Hispanic Asian/Pacific Islander patients (OR 0.84, 95% CI 0.79 to 0.90) and odds of discharge from a CSC were lower for Hispanic (OR 0.91, 95% CI 0.85 to 0.97) and non‐Hispanic Black patients (OR 0.74, 95% CI 0.67 to 0.81). Conclusions There are racial and ethnic disparities in reperfusion intervention receipt among stroke patients in California. Stroke system of care design, hospital resources, and transfer patterns may contribute to this disparity. |
| first_indexed | 2024-12-10T09:22:35Z |
| format | Article |
| id | doaj.art-f628087d82284a1cb2a1ec49206ee8cd |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-12-10T09:22:35Z |
| publishDate | 2022-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-f628087d82284a1cb2a1ec49206ee8cd2022-12-22T01:54:38ZengWileyJournal of the American College of Emergency Physicians Open2688-11522022-04-0132n/an/a10.1002/emp2.12706The relationship between stroke system organization and disparities in access to stroke center care in CaliforniaKori S. Zachrison0Margaret E. Samuels‐Kalow1Sijia Li2Zhiyu Yan3Mathew J. Reeves4Renee Y. Hsia5Lee H. Schwamm6Carlos A. Camargo Jr7Department of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USADepartment of Neurology Massachusetts General Hospital Boston Massachusetts USADepartment of Epidemiology and Biostatistics Michigan State University East Lansing Michigan USADepartment of Emergency Medicine University of California San Francisco San Francisco California USADepartment of Neurology Massachusetts General Hospital Boston Massachusetts USADepartment of Emergency Medicine Massachusetts General Hospital Boston Massachusetts USAAbstract Background There are significant racial and ethnic disparities in receipt of reperfusion interventions for acute ischemic stroke. Our objective was to determine whether there are disparities in access to stroke center care by race or ethnicity that help explain differences in reperfusion therapy and to understand whether interhospital patient transfer plays a role in improving access. Methods Using statewide administrating data including all emergency department and hospital discharges in California from 2010 to 2017, we identified all acute ischemic stroke patients. Primary outcomes of interest included presentation to primary or comprehensive stroke center (PSC or CSC), interhospital transfer, discharge from PSC or CSC, and discharge from CSC alone. We used hierarchical logistic regression modeling to identify the relationship between patient‐ and hospital‐level characteristics and outcomes of interest. Results Of 336,247 ischemic stroke patients, 55.4% were non‐Hispanic White, 19.6% Hispanic, 10.6% non‐Hispanic Asian/Pacific Islander, and 10.3% non‐Hispanic Black. There was no difference in initial presentation to stroke center hospitals between groups. However, adjusted odds of reperfusion intervention, interhospital transfer and discharge from CSC did vary by race and ethnicity. Adjusted odds of interhospital transfer were lower among Hispanic (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.89 to 0.98) and non‐Hispanic Asian/Pacific Islander patients (OR 0.84, 95% CI 0.79 to 0.90) and odds of discharge from a CSC were lower for Hispanic (OR 0.91, 95% CI 0.85 to 0.97) and non‐Hispanic Black patients (OR 0.74, 95% CI 0.67 to 0.81). Conclusions There are racial and ethnic disparities in reperfusion intervention receipt among stroke patients in California. Stroke system of care design, hospital resources, and transfer patterns may contribute to this disparity.https://doi.org/10.1002/emp2.12706disparitiesischemic strokereperfusionstroke centerthrombolysis |
| spellingShingle | Kori S. Zachrison Margaret E. Samuels‐Kalow Sijia Li Zhiyu Yan Mathew J. Reeves Renee Y. Hsia Lee H. Schwamm Carlos A. Camargo Jr The relationship between stroke system organization and disparities in access to stroke center care in California Journal of the American College of Emergency Physicians Open disparities ischemic stroke reperfusion stroke center thrombolysis |
| title | The relationship between stroke system organization and disparities in access to stroke center care in California |
| title_full | The relationship between stroke system organization and disparities in access to stroke center care in California |
| title_fullStr | The relationship between stroke system organization and disparities in access to stroke center care in California |
| title_full_unstemmed | The relationship between stroke system organization and disparities in access to stroke center care in California |
| title_short | The relationship between stroke system organization and disparities in access to stroke center care in California |
| title_sort | relationship between stroke system organization and disparities in access to stroke center care in california |
| topic | disparities ischemic stroke reperfusion stroke center thrombolysis |
| url | https://doi.org/10.1002/emp2.12706 |
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