Date of Award


Degree Type

Closed Thesis

Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Michael Eriksen, ScD - Chair

Second Advisor

Andrea Winquist, MD

Third Advisor

Ike Okosun, PhD, MS


Stroke is the third leading cause of death in the United States, as well as Georgia. In 2003, 23,164 Georgians suffered a stroke and of those 4,285 died. The FDA has currently approved a therapy that must be given within a three hour window. Less than 2% of stroke patients receive this therapy, oftentimes because of delay of hospital arrival. The purpose of this study is to examine the differences in rural and urban Georgia in patients’ times from stroke symptom onset to hospital arrival. Data from hospitals that area a part of the Georgia Coverdell Stroke Registry from 2005-2007 were analyzed. Logistic regression analysis found that arriving to a rural hospital, being of white race, and having an age of over 60 were associated with greater odds of arriving to the hospital within two hours. Arriving at the hospital by EMS transfer from another hospital, arriving by other means (patient arrived in a personal car or was brought by someone) and having undocumented arrival mode were all associated with a greater odds of arriving much later to the hospital. The multivariate logistic regression had similar findings, although having an age of over 60 years was no longer significantly associated with arrival within 120 minutes. Findings show the need for increased educational efforts around signs and symptoms of stroke, and calling 9-1-1 should be a part of all educational campaigns. Recommendations for improved data collection and additional research are made.