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Updated: Mar 9, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Progressive rural-urban disparity in acute stroke care
Sergio Gonzales1, Michael T Mullen1, Lesli Skolarus1
1From the Leonard Davis Institute of Health Economics (S.G., M.T.M., A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.P.T., A.W.W.), and Department of Biostatistics and Epidemiology (A.W.W.), University of Pennsylvania; Department of Neurology (S.G., M.T.M., D.P.T., A.W.W.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (L.S., A.W.W.), University of Michigan, Ann Arbor; and Dorsnsife School of Public Health (U.U.), Drexel University, Philadelphia, PA.
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 worsened: tPA 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.
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