Education Level and Inequalities in Stroke Reperfusion Therapy Observations in the Swedish Stroke Register

This just proves that tPA should be considered a complete failure and something better found. Beating a dead horse is not going to make it race any faster. And yet I bet our stroke medical world will continue down the same failed path for years to come. Unless we overthrow them all.  Notice that they don't talk about results(how many fully recovered due to tPA?). They talk about reperfusion as if that is the important thing to measure. It's not. 
GAH!!! The Stupidity.
http://stroke.ahajournals.org/content/early/2014/07/29/STROKEAHA.114.005323.abstract?sid=f5ba2ff2-c68f-4a20-9420-a2bf07af24c0

1. Anna Stecksén, RPT, MSc,
2. Eva-Lotta Glader, MD, PhD,
3. Kjell Asplund, MD, PhD,
4. Bo Norrving, MD, PhD and
5. Marie Eriksson, PhD

+ Author Affiliations

1. From the Departments of Public Health and Clinical Medicine (A.S., E.-L.G., K.A.) and Statistics (M.E.), Umeå University, Umeå, Sweden; and Department of Clinical Sciences, Section of Neurology, Lund University, Lund, Sweden (B.N.).

1. Correspondence to Anna Stecksén, RPT, MSc, Department of Public Health and Clinical Medicine, Umeå University, S-901 87 Umeå, Sweden. E-mail anna.stecksen@medicin.umu.se

Abstract

Background and Purpose—Previous studies have revealed inequalities in stroke treatment based on demographics, hospital type, and region. We used the Swedish Stroke Register (Riksstroke) to test whether patient education level is associated with reperfusion (either or both of thrombolysis and thrombectomy) treatment.

Methods—We included 85 885 patients with ischemic stroke aged 18 to 80 years registered in Riksstroke between 2003 and 2009. Education level was retrieved from Statistics Sweden, and thrombolysis, thrombectomy, patient, and hospital data were obtained from Riksstroke. We used multivariable logistic regression to analyze the association between reperfusion therapy and patient education.

Results—A total of 3649 (4.2%) of the patients received reperfusion therapy. University-educated patients were more likely to be treated (5.5%) than patients with secondary (4.6%) or primary education (3.6%; P<0.001). The inequality associated with education was still present after adjustment for patient characteristics; university education odds ratio, 1.14; 95% confidence interval, 1.03 to 1.26 and secondary education odds ratio, 1.08; 95% confidence interval, 1.00 to 1.17 compared with primary education. Higher hospital specialization level was also associated with higher reperfusion levels (P<0.001). In stratified multivariable analyses by hospital type, significant treatment differences by education level existed only among large nonuniversity hospitals (university education odds ratio, 1.20; 95% confidence interval, 1.04–1.40; secondary education odds ratio, 1.14; 95% confidence interval, 1.01–1.29).

Conclusions—We demonstrated a social stratification in reperfusion, partly explained by patient characteristics and the local hospital specialization level. Further studies should address treatment delays, stroke knowledge, and means to improve reperfusion implementation in less specialized hospitals.