Abstract 29: Low Socioeconomic Status and Longer Home-to-Hospital Distances Are Associated With Less Timely Treatment of Ischemic Stroke

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Introduction: Many patients with ischemic stroke do not receive tissue plasminogen activator (tPA) due to late arrival to the hospital. We assessed whether socioeconomic status (SES) and home-to-hospital driving-times impact tPA administration and timeliness of treatment, and evaluated the interaction between SES and driving time. Methods: We conducted a retrospective observational study using data collected from Get With The Guidelines-Stroke between January 2015 to March 2017. The study included 118,683 ischemic stroke patients age ≥18 from 1,489 US hospitals across the US. All patients arrived via EMS from a non-healthcare facility within 24 hours of symptom onset. We estimated patient SES using zip code median household income, and 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), analyzed using hierarchical multivariable logistic regression models with random intercepts to account for clustering at the hospital level. Results: Patients had a median OTA of 155 minutes (64-484) and 26.5% were treated with tPA. Zip code median income quintiles were $46,400, $52,136, $57,895 and $70,150. Driving time quartiles were 13.5, 20.7 and 32.1 minutes. SES was not significantly associated with tPA administration (p=0.47) or OTA (p=0.31). However, lower SES was associated with longer symptom onset to treatment time (p=0.02) and higher in-hospital mortality (p=0.004). Longer driving time (comparing top to bottom quartile) was associated with a lower rate of tPA administration (OR 0.83, 0.79-0.88, p <0.001), and longer OTA (OR 1.30, 1.24-1.35, p<0.001). Lower SES was associated with slightly longer driving times (r = -0.04, p=0.004), but there was no interaction between SES and driving time for either OTA (p=0.11) or rate of tPA administration (p=0.61). Conclusions: Longer home-to-hospital driving times were associated with lower rates of tPA and longer OTA, however SES did not modify these associations.