{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T04:29:33Z","timestamp":1775622573675,"version":"3.50.1"},"reference-count":65,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2015,10,27]]},"abstract":"\n Background<\/jats:title>\n \n Primary stroke centers (\n PSC<\/jats:styled-content>\n s) utilize more recombinant tissue plasminogen activator (rt\u2010\n PA<\/jats:styled-content>\n ) than non\u2010\n PSC<\/jats:styled-content>\n s. The impact of\n PSC<\/jats:styled-content>\n s on racial disparities in rt\u2010\n PA<\/jats:styled-content>\n use is unknown.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We used data from the Nationwide Inpatient Sample from 2004 to 2010, limited to states that publicly reported hospital identity and race. Hospitals certified as\n PSC<\/jats:styled-content>\n s by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt\u2010\n PA<\/jats:styled-content>\n use was defined by the International Classification of Diseases, 9\n th<\/jats:sup>\n Revision procedure code 99.10. Discharges (304\u00a0152 patients) from 26 states met eligibility criteria, and of these 71.5% were white, 15.0% black, 7.9% Hispanic, and 5.6% other. Overall, 24.7% of white, 27.4% of black, 16.2% of Hispanic, and 29.8% of other patients presented to\n PSC<\/jats:styled-content>\n s. A higher proportion received rt\u2010\n PA<\/jats:styled-content>\n at\n PSC<\/jats:styled-content>\n s than non\u2010\n PSC<\/jats:styled-content>\n s in all race\/ethnic groups (white 7.6% versus 2.6%, black 4.8% versus 2.0%, Hispanic 7.1% versus 2.4%, other 7.2% versus 2.5%, all\n P<\/jats:italic>\n <0.001). In a multivariable model adjusting for year, age, sex, insurance, medical comorbidities, a diagnosis\u2010related group\u2013based mortality risk indicator,\n ZIP<\/jats:styled-content>\n code median income, and hospital characteristics, blacks were less likely to receive rt\u2010\n PA<\/jats:styled-content>\n than whites at non\u2010\n PSC<\/jats:styled-content>\n s (odds ratio=0.58, 95%\n CI<\/jats:styled-content>\n 0.50 to 0.67) and\n PSC<\/jats:styled-content>\n s (odds ratio=0.63, 95%\n CI<\/jats:styled-content>\n 0.54 to 0.74) and Hispanics were less likely than whites to receive rt\u2010\n PA<\/jats:styled-content>\n at\n PSC<\/jats:styled-content>\n s (odds ratio=0.77, 95%\n CI<\/jats:styled-content>\n : 0.63 to 0.95). In the fully adjusted model, interaction between race and presentation to a\n PSC<\/jats:styled-content>\n for likelihood of receiving rt\u2010\n PA<\/jats:styled-content>\n did not reach significance (\n P<\/jats:italic>\n =0.98).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Racial disparities in intravenous rt\u2010\n PA<\/jats:styled-content>\n use were not reduced by presentation to\n PSC<\/jats:styled-content>\n s. Black patients were less likely to receive thrombolytic treatment than white patients at both non\u2010\n PSC<\/jats:styled-content>\n s and\n PSC<\/jats:styled-content>\n s. Hispanic patients were less likely to be seen at\n PSC<\/jats:styled-content>\n s relative to white patients and were less likely to receive intravenous rt\u2010\n PA<\/jats:styled-content>\n in the fully adjusted model.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.115.001877","type":"journal-article","created":{"date-parts":[[2015,10,15]],"date-time":"2015-10-15T02:59:37Z","timestamp":1444877977000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":57,"title":["Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers"],"prefix":"10.1161","volume":"4","author":[{"given":"Hugo J.","family":"Aparicio","sequence":"first","affiliation":[{"name":"Department of Neurology, Boston University, Boston, MA"},{"name":"Department of Neurology, University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan G.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott E.","family":"Kasner","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Kallan","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology & Biostatistics, University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen C.","family":"Albright","sequence":"additional","affiliation":[{"name":"Health Services and Outcomes Research Center for Outcome and Effectiveness Research and Education, University of Alabama at Birmingham, AL"},{"name":"Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities\/Minority Health & Health Disparities Research Center, University of Alabama at Birmingham, AL"},{"name":"Department of Epidemiology, University of Alabama at Birmingham, AL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dawn O.","family":"Kleindorfer","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Cincinnati, OH"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael T.","family":"Mullen","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Pennsylvania, Philadelphia, PA"},{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.11.1649"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.192535"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.11.005"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.000095"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.WNL.0000151850.39648.51"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.8.1015"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/NRL.0b013e318248ea3c"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.5.1061"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2012.06.004"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.962829"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.000162"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.113.000089"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.615336"},{"key":"e_1_3_4_15_2","unstructured":"Facts about primary stroke center certification. The Joint Commission website. 2015. Available at: http:\/\/www.jointcommission.org\/facts_about_primary_stroke_center_certification\/. Accessed January 30 2015."},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.657809"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.640060"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.112.000071"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.22"},{"key":"e_1_3_4_20_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31821e54f3"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.001457"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.8.1832"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.613828"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.01.021"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.07.003"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000063364.88309.27"},{"key":"e_1_3_4_27_2","first-page":"29","article-title":"Ethnic disparities trump other risk factors in determining delay to emergency department arrival in acute ischemic stroke","volume":"23","author":"Siegler JE","year":"2013","unstructured":"Siegler JE, Boehme AK, Albright KC, Martin\u2010Schild S. Ethnic disparities trump other risk factors in determining delay to emergency department arrival in acute ischemic stroke. Ethn Dis. 2013;23:29\u201334.","journal-title":"Ethn Dis"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.881490"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e3182213e24"},{"key":"e_1_3_4_30_2","unstructured":"Overview of the National (Nationwide) Inpatient Sample (NIS) . Healthcare cost and utilization project website. 2015. Available at: http:\/\/www.hcup-us.ahrq.gov\/nisoverview.jsp. Accessed January 30 2015."},{"key":"e_1_3_4_31_2","unstructured":"Andrade SH Tjia J Cutrona S Saczynski J Goldberg R Gurwitz J. Mini\u2010sentinel systematic evaluation of health outcome of interest definitions for studies using administrative data: cerebrovascular\/transient ischemic attack report. 2011."},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_3_4_33_2","first-page":"46","article-title":"A closer look at all\u2010patient refined DRGs","volume":"73","author":"Averill RF","year":"2002","unstructured":"Averill RF, Goldfield NI, Muldoon J, Steinbeck BA, Grant TM. A closer look at all\u2010patient refined DRGs. J AHIMA. 2002;73:46\u201350.","journal-title":"J AHIMA"},{"key":"e_1_3_4_34_2","unstructured":"U.S. Census Bureau projections show a slower growing older more diverse nation a half century from now. United States Census Bureau website. 2012. Available at: https:\/\/www.census.gov\/newsroom\/releases\/archives\/population\/cb12-243.html. Accessed January 30 2015."},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e31829734f2"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000441139.02102.80"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.000691"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.23972"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.575043"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000153065.39325.fd"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2011.09.018"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011389105821"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.006021"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.114.006819"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2008.05.010"},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.892497"},{"key":"e_1_3_4_47_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31824d966b"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2004.040543"},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10072-014-1640-9"},{"key":"e_1_3_4_50_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003912"},{"key":"e_1_3_4_51_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.176040"},{"key":"e_1_3_4_52_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2004.06.019"},{"key":"e_1_3_4_53_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.32.1.63"},{"key":"e_1_3_4_54_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.31.11.2585"},{"key":"e_1_3_4_55_2","doi-asserted-by":"publisher","DOI":"10.1159\/000109691"},{"key":"e_1_3_4_56_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-129-3-199808010-00005"},{"key":"e_1_3_4_57_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.51.2.427"},{"key":"e_1_3_4_58_2","doi-asserted-by":"publisher","DOI":"10.1159\/000054787"},{"key":"e_1_3_4_59_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(99)70431-2"},{"key":"e_1_3_4_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jstrokecerebrovasdis.2013.11.003"},{"key":"e_1_3_4_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2008.02.004"},{"key":"e_1_3_4_62_2","unstructured":"Ennis SR R\u00edos\u2010Vargas M Albert NG. The Hispanic Population: 2010. United\u00a0States Census Bureau website. 2011. Available at: http:\/\/www.census.gov\/prod\/cen2010\/briefs\/c2010br-04.pdf. Accessed January 30 2015."},{"key":"e_1_3_4_63_2","unstructured":"Rastogi S Johnson TD Hoeffel EM Drewery J Malcolm P. The Black Population: 2010. United States Census Bureau website. 2011. Available at: http:\/\/www.census.gov\/prod\/cen2010\/briefs\/c2010br-06.pdf. Accessed January 30 2015."},{"key":"e_1_3_4_64_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.107.490375"},{"key":"e_1_3_4_65_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.612358"},{"key":"e_1_3_4_66_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2006.01.004"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.115.001877","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:14:05Z","timestamp":1715595245000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.115.001877"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,10,27]]},"references-count":65,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2015,10,27]]}},"alternative-id":["10.1161\/JAHA.115.001877"],"URL":"https:\/\/doi.org\/10.1161\/jaha.115.001877","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,10,27]]},"assertion":[{"value":"2015-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-07-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-10-14","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e001877"}}