Abstract 14149: Access to Neurology and Telestroke Services in Rural America

Abstract

Introduction: Stroke and other neurologic diseases may disproportionately affect persons in rural areas, and stroke-related mortality in rural counties has increased in recent years. Little is known about distribution and trends in neurologists and telestroke services in rural vs urban counties in the US. Methods: Volume and age distribution of neurologists in each county were determined using the AMA Physician Masterfile for each year 2010-2018. Neurologist density (per 100,000 persons) was estimated based on county-level population data. Telestroke units per county were identified using Area Health Resource files. Counties were classified as large metropolitan, medium or small metropolitan, or rural based on CDC WONDER designations. Results: From 2010-2018, mean (SD) neurologist density in rural counties decreased from 6.3 (21.6) to 5.9 (18.7) per 100,000 persons. A majority of rural counties experienced little to no change (0-5 per 100,000) in neurologist density over time. In contrast, neurologist density increased in large metropolitan counties from 31.1 (42.7) to 37.8 (52.1) per 100,000 and in medium/small metropolitan counties from 29.3 (67.8) to 32.2 (74.9) per 100,000. Over time, 42% of large metropolitan and 27% of medium/small metropolitan counties experienced >10 per 100,000 longitudinal increases in neurologist density. The proportion of younger neurologists (<35 or 35-44 years) appeared to increase in urban counties, while the proportion of older neurologists (≥65 years) relatively increased in rural counties. In 2018, telestroke units were available in 51%, 37%, and 18% of large metropolitan, medium/small metropolitan, and rural counties, respectively. Conclusions: Neurologist density has decreased in rural counties in the US, with a relative aging of existing neurologists in these settings. Four out of 5 rural counties do not have telestroke units. These data underscore the need to improve access to neurology in rural areas.