Progressive rural–urban disparity in acute stroke care

OBJECTIVE:To explore rural–urban differences and trends in tissue plasminogen activator (tPA) utilization among acute ischemic stroke (AIS) patients and examine the association between primary stroke center (PSC) growth and geographic disparity in tPA use. METHODS:We used hospital discharge data from the National Inpatient Sample (NIS) from 2000 to 2010 and indicators of tPA utilization and describe temporal trends in geographic disparities in AIS care during PSC growth. The Gini coefficient was used to quantify rural–urban inequity in tPA use at the state level (from 0% to 100% of maximum potential rural–urban inequity) in tPA use. RESULTS:Of 914,500 cases of AIS between 2001 and 2010, 2.3% (n = 21, 190) received tPA. The rural–urban disparity in tPA worsenedtPA use in urban hospitals quadrupled (1.17%–4.87%) compared to rural hospitals (0.87%–1.59%). Of 33 states with NIS data, 15 reached at least 75% of the maximum rural–urban inequality from 2004 to 2010. CONCLUSIONS:Geographic disparities in tPA use for AIS are increasing. Greater understanding of the effectors of tPA utilization is necessary to ensure that access to tPA treatment is equitable for all communities in the United States.