Objective:

The objective of this study was to determine the association between social determinants of health (SDOH) and receipt of thrombolysis within 30-minutes of DTN. 

Background:

The American Heart Association has recommended a goal door to needle time (DTN) of less than 30 minutes for at least 50% of patients presenting with ischemic stroke within the 4.5-hour time window.

Design/Methods:

This study was a retrospective, single-center, cohort study of acute stroke patients who received intravenous thrombolysis using data from the electronic medical record (EMR) and Get with the Guidelines (GWTG). DTN, age, sex, race, insurance status and the social vulnerability index (SVI) were abstracted from the EMR. The SVI has 4 subcategories (socioeconomic status, household characteristics, racial and ethnic minority status and housing type and transportation). Additional information on patient clinical variables was taken from GWTG. Logistic regression was used to model the association between the age, sex, race, insurance status and SVI and receipt of thrombolysis within 30 minutes of DTN. Multiple imputation was used for missing data.

Results:

A total of 164 patients received intravenous thrombolysis between September 2022 to May 2025 with 27 (16.5%) patients receiving thrombolysis within 30 minutes of arrival. Patients who were non-white were less likely to achieve a 30-minute DTN (p<0.01).  No other SDOH were significantly associated with receipt of thrombolysis in a 30-minute DTN. Non-white patients were less likely to receive thrombolysis within the 30-minute window (OR 0.10 (95%CI (0.01-0.73)) after adjustment for age, sex, insurance status, 4 subscales of SVI, co-morbidities, NIH stroke scale on admission, large vessel occlusion, relative contraindications for thrombolysis, initial blood pressure too high for thrombolysis, and anti-thrombotic medications.

Conclusions:

Non-white patients were significantly less likely to receive treatment within 30 minutes of hospital arrival. These findings underscore the value of equitable treatment delivery in acute stroke care.