Racial Disparities in Intravenous Recombinant Tissue Plasminogen Activator Use Persist at Primary Stroke Centers

Background Primary stroke centers ( PSC s) utilize more recombinant tissue plasminogen activator (rt‐ PA ) than non‐ PSC s. The impact of PSC s on racial disparities in rt‐ PA use is unknown. Methods and Results 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 PSC s by The Joint Commission were identified. Adults with a diagnosis of ischemic stroke were analyzed. Rt‐ PA use was defined by the International Classification of Diseases, 9 th Revision procedure code 99.10. Discharges (304 152 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 PSC s. A higher proportion received rt‐ PA at PSC s than non‐ PSC 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 P <0.001). In a multivariable model adjusting for year, age, sex, insurance, medical comorbidities, a diagnosis‐related group–based mortality risk indicator, ZIP code median income, and hospital characteristics, blacks were less likely to receive rt‐ PA than whites at non‐ PSC s (odds ratio=0.58, 95% CI 0.50 to 0.67) and PSC s (odds ratio=0.63, 95% CI 0.54 to 0.74) and Hispanics were less likely than whites to receive rt‐ PA at PSC s (odds ratio=0.77, 95% CI : 0.63 to 0.95). In the fully adjusted model, interaction between race and presentation to a PSC for likelihood of receiving rt‐ PA did not reach significance ( P =0.98). Conclusions Racial disparities in intravenous rt‐ PA use were not reduced by presentation to PSC s. Black patients were less likely to receive thrombolytic treatment than white patients at both non‐ PSC s and PSC s. Hispanic patients were less likely to be seen at PSC s relative to white patients and were less likely to receive intravenous rt‐ PA in the fully adjusted model.