Abstract 60
Disparities In Rates Of Thrombolytic Use And Discharge Disposition Among Acute Ischemic Stroke According To Socioeconomic Status In United States
- Jani, Vishal B
- Lahewala, Sopan
- Arora, Shilpkumar
- Patel, Achint
- Hussain, Syed
- Razak, Anmar
- Qureshi, Mushtaq
- Safdar, Adnan
- Kassab, Mounzer
- Majid, Arshad
- Gidwani, Umesh
- Suri, Fareed
- Hassan, Ameer
- Qureshi, Adnan
Background: We aim to study difference in acute care and incidence of acute stroke according to socioeconomic status.
Methods: We reviewed the data from HCUP's Nationwide Inpatient Sample (NIS) database from 2008 - 11 for all emergency room (ER) admissions for pts aged ≥18 years for acute ischemic stroke using ICD 9-CM codes. Hierarchical two level regression model was used to adjust for age, gender, weekend admission, primary payer, hospital region, teaching status, bed size (with hospital ID as random effect) to compare different socio-economical status (SES) based on household income for rates of thrombolytic use, in-hospital mortality, discharge disposition after excluding dead people, hospital charges and length of stay (LOS). LOS was calculated only in pts who were alive. Cost to charge ratio files were merged with NIS to calculate cost of care. The cost of care was adjusted for inflation with reference to 2011.
Results: Total 390,401 (weighted: 1,933,243) ER admissions for AIS were analyzed (53.4% females, 60.8% whites). Mean age of pts was 71 years. In-hospital mortality was 7.2%. After adjusting for confounders; compared with pts in lowest income quartile (qtl), higher SES groups had higher utilization of IV thrombolytics (OR, 95% CI, P-value) (4th qtl: 1.44, 1.30 - 1.59, p<0.001; 3rd qtl: 1.33, 1.22 - 1.44, p<0.001 & 2nd qtl: 1.16, 1.08 - 1.25, p<0.001). But decreased discharge to long term facility (4th qtl: 0.84, 0.79 - 0.90, p<0.001; 3rd qtl: 0.93, 0.90 - 0.96, p<0.001 & 2nd qtl: 0.96, 0.93 - 0.99, p=0.006) and lower in in-hospital mortality (4th qtl: 0.87, 0.82 - 0.92, p < 0.001, 3rd qtl: 0.89, 0.85 - 0.93, p<0.001). There was significant difference in LOS but no difference in cost of care between different SES groups.
Conclusions: There is significant disparity in utilization of thrombolytics, discharge disposition and in-hospital mortality amongst different SES groups. Strategies targeting people in low socioeconomic groups to promote access to effective stroke interventions are required to reduce the observed disparity.