医院距离、社会经济地位与缺血性脑卒中的及时治疗。
Hospital distance, socioeconomic status, and timely treatment of ischemic stroke.
机构信息
From the Department of Neurology (J.A.), Columbia University Medical Center, New York, NY; Duke Clinical Research Institute (J.W., S.S., Y.X., R.A.M.), Durham, NC; Division of Cardiology (G.C.F.), Ronald Reagan-UCLA Medical Center, Los Angeles, CA; Department of Clinical Neurosciences and Hotchkiss Brain Institute (E.E.S.), University of Calgary, Canada; Department of Neurology (S.S.), Duke University Hospital; Department of Neurology (Y.X.), Duke University Medical Center, Durham, NC; Brigham and Women's Hospital Heart & Vascular Center (D.L.B.) and Department of Neurology, Massachusetts General Hospital (L.H.S.), Harvard Medical School, Boston; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Department of Biostatistics and Bioinformatics (R.A.M.), Duke University, Durham, NC; and Department of Neurology (K.N.S.), Division of Neurocritical Care & Emergency Neurology, Yale University, New Haven, CT.
出版信息
Neurology. 2019 Aug 20;93(8):e747-e757. doi: 10.1212/WNL.0000000000007963. Epub 2019 Jul 18.
OBJECTIVE
To determine whether lower socioeconomic status (SES) and longer home to hospital driving time are associated with reductions in tissue plasminogen activator (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 and March 2017. The study included 118,683 ischemic stroke patients age ≥18 who were transported by emergency medical services to one of 1,489 US hospitals. We defined each patient's SES based on zip code median household income. We calculated the driving time between each patient's home zip code and the hospital where he or she was 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 ( = 0.31) or tPA administration ( = 0.47), but was associated with the secondary outcomes of onset-to-treatment time (OTT) ( = 0.0160) and in-hospital mortality ( = 0.0037), with higher SES associated with shorter OTT and lower in-hospital mortality. Driving time was associated with tPA administration ( < 0.001) and OTA ( < 0.0001), with lower odds of tPA (0.83, 0.79-0.88) and longer OTA (1.30, 1.24-1.35) in patients with the longest vs shortest driving time quartiles. Lower SES quintiles were associated with slightly longer driving time quartiles ( = 0.0029), but there was no interaction between the SES and driving time for either OTA ( = 0.1145) or tPA ( = 0.6103).
CONCLUSIONS
Longer driving times were associated with lower odds of tPA administration and longer OTA; however, SES did not modify these associations.
目的
确定较低的社会经济地位（SES）和更长的从家到医院的驾驶时间是否与组织型纤溶酶原激活物（tPA）的给药减少和治疗的及时性有关。
方法
我们使用了 2015 年 1 月至 2017 年 3 月期间来自 Get With The Guidelines-Stroke 登记处（GWTG-Stroke）的数据进行了回顾性观察性研究。该研究包括 118683 名年龄≥18 岁的缺血性脑卒中患者，他们由紧急医疗服务机构运送至美国 1489 家医院之一。我们根据邮政编码中位数家庭收入来定义每个患者的 SES。我们使用 Google Maps 方向应用程序编程接口（API）计算每位患者家庭邮政编码与其接受治疗的医院之间的驾驶时间。主要结局是 tPA 给药和发病至到达时间（OTA）。使用分层多变量逻辑回归模型分析结局。
结果
SES 与 OTA 无关（ = 0.31）或 tPA 给药无关（ = 0.47），但与发病至治疗时间（OTT）有关（ = 0.0160）和院内死亡率有关（ = 0.0037），SES 越高，OTT 越短，院内死亡率越低。驾驶时间与 tPA 给药（<0.001）和 OTA（<0.0001）有关，在驾驶时间最长与最短的四分位数患者中，tPA 的几率较低（0.83，0.79-0.88），OTA 较长（1.30，1.24-1.35）。SES 五分位数较低的患者与驾驶时间四分位数稍长有关（ = 0.0029），但 OTA（ = 0.1145）或 tPA（ = 0.6103）的 SES 和驾驶时间之间没有相互作用。
结论
较长的驾驶时间与 tPA 给药减少和 OTA 延长有关；然而，SES 并没有改变这些关联。
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